Understanding Serum Protein Electrophoresis (SPEP) for Multiple Myeloma

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Editor’s Note: This resource, Understanding Serum Protein Electrophoresis (SPEP) for Multiple Myeloma, was originally published by MyHealthTeam.

A variety of tests play a role in diagnosing multiple myeloma, including serum protein electrophoresis (SPEP). SPEP is a type of blood test, similar to one called immunofixation electrophoresis (IFE). It is used to measure and identify large amounts of monoclonal proteins (M proteins) in the blood. These are substances that can be indicative of illnesses such as multiple myeloma.

Understanding more about SPEP, including how it’s done, what to expect, and how to interpret the results, can help increase your understanding of a multiple myeloma diagnosis.

How Serum Protein Electrophoresis (SPEP) Works

SPEP is one of the tests typically used to identify the presence of multiple myeloma. Aside from M-protein detection, serum protein electrophoresis is used to check for immunoglobulins or antibodies. Immunoglobulins are responsible for the body’s defense systems. Some different types of immunoglobulins include immunoglobulin M (IgM), immunoglobulin G (IgG), and immunoglobulin A (IgA).

In some cases, the test is performed with urine, called a urine protein electrophoresis. A doctor may use this approach if they suspect that an immunoglobulin component called light chains is being lost in the urine. This type of protein is also called Bence-Jones protein.

“Blood serum” refers to the plasma portion of the blood without the blood’s clotting agents present. When a person’s blood is brought to the laboratory for analysis, it is separated into different components, including serum, and different kinds of tests can be run on each component.

SPEP measures levels of five protein types:

  • Albumin
  • Alpha-1 globulin
  • Alpha-2 globulin
  • Beta globulin
  • Gamma globulin

Each protein moves at a different speed and clumps together under electric current to form specific patterns. As part of the test process, each component is separately examined and compared with amounts that are found in healthy individuals. Their patterns are also examined for any deviations.

An abnormal amount of protein in the blood serum can indicate a problem with protein production, which may be due to an underlying condition. After getting SPEP results, doctors usually order follow-up examinations to pinpoint the culprit behind the unusual protein levels in the body.

When Serum Protein Electrophoresis (SPEP) Is Used

SPEP is generally indicated if you have signs and symptoms that suggest the presence of conditions related to unusual protein levels in your body. Some of these signs and symptoms include the following:

  • Carpal tunnel syndrome that doesn’t seem to improve
  • Manifestations of high calcium levels, such as chronic episodes of constipation, fatigue, loss of appetite, nausea, headaches, and thirst
  • Weakened bones, as evidenced by frequent episodes of fractures or bone pain
  • Excessive bruising or bleeding
  • Anemia (low red blood cell count)
  • Certain lymphomas and leukemias that may be producing monoclonal protein

In some cases, specialists do not see these signs or symptoms right away. Instead, they may first notice a problem when laboratory results indicate high levels of protein in your blood cells or urine. In the case of hypercalcemia (high calcium levels), for instance, doctors may recommend that you undergo SPEP or IFE to help rule out potential causes.

How SPEP Is Conducted

Preparing for SPEP involves largely the same process as going in for other blood tests and laboratory testing. You may need to temporarily stop taking some medications, depending on your doctor’s advice. You won’t typically have to do anything further prior to your appointment.

During the test, the health professional will wrap a band (tourniquet) around your arm to stop the blood flow in the area. This causes veins to swell, making them easier to identify and puncture. This, in turn, will make it simpler for the person drawing your blood to insert the needle. The area will be cleaned and sanitized with an alcohol swab before needle insertion.

Once the health professional inserts the needle, they will extract the recommended amount of blood. They will then remove the needle and apply pressure to the extraction site with a small gauze pad to keep it from bleeding. Your next step is to wait for the results after the blood sample is processed by the laboratory.

Once your sample has been processed, a health care provider will look at the results. This will include the amount of each protein found in the assay as part of the diagnostic process. To make the process more accurate, they will consider the results alongside your other signs and symptoms.

Your health care provider will compare your levels to reference ranges, the typical blood concentrations of different substances. These are expressed in grams per deciliter (sometimes written as g/dL), but these ranges may vary slightly from lab to lab. For adults, the reference ranges are:

  • Total protein — 6.3 to 7.9 grams per deciliter
  • Albumin — 3.4 to 4.7 grams per deciliter
  • Alpha-1 globulin — 0.1 to 0.3 grams per deciliter
  • Alpha-2 globulin — 0.6 to 1 grams per deciliter
  • Beta globulin — 0.7 to 1.2 grams per deciliter
  • Gamma globulin — 0.6 to 1.6 grams per deciliter

The reference values for the total protein tests have yet to be established for children younger than 12 months of age.

What SPEP Can Tell Doctors

It is important to remember that the results of SPEP are not definitive on their own. Your doctors will take a number of different factors into account alongside your results when providing you with a diagnosis.

A decrease in total serum protein may indicate one of the following conditions:

  • Malnutrition
  • Kidney disease
  • Nephrotic syndrome
  • Liver disease
  • Cirrhosis (scarring of the liver)
  • Inability of the digestive system to absorb and process protein

An increase in alpha-1 globulin may be indicative of inflammatory disease or cancer.

Higher than normal alpha-2 globulin may mean acute or chronic inflammation.

An increase in beta fraction globulin and its components (C3, transferrin, and beta-lipoprotein) may be due to hormonal medications or the body’s inability to break down fats.

A decrease in beta globulin may translate to malnutrition or low levels of cholesterol.

An increase in gamma globulin protein may indicate:

  • Blood cancers such as multiple myeloma
  • Liver disease
  • Presence of an infection
  • Inflammatory disease

Your medical history, such as recent vaccinations or the medications you take, may affect the results of laboratory tests. Therefore, your oncology team will check your medical history and all the drugs that you currently take to better interpret the results of your SPEP.

How SPEP Results Are Used

The immunofixation results themselves cannot specifically indicate the underlying problem. Depending on the type of protein that you have in your blood at unusual levels, your oncology team may recommend another series of laboratory tests to rule out other conditions.

Following SPEP testing, your health care team may order more assays or proceed to other examinations, such as a bone marrow biopsy or more blood tests for additional information about your diagnosis.

Meet Your Team

Going through a series of tests can be overwhelming, but having a strong support system can make a world of difference. MyMyelomaTeam provides a safe space where you can discuss experiences, offer advice, and interact with others who understand life with multiple myeloma. This growing community is already more than 16,000 people strong.

Have you undergone SPEP during the diagnostic process? What was it like? Share your thoughts and advice in the comments below, or start a conversation by posting on MyMyelomaTeam.

Lymphoma Rashes: Symptoms and Treatments

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Editor’s Note: This resource, Lymphoma Rashes: Symptoms and Treatments, was originally published by MyHealthTeam.

When most people think of lymphoma symptoms, a rash isn’t usually something that comes to mind. For some types of lymphoma rashes aren’t an issue, but rashes are a symptom in several different lymphomas.

Cutaneous T-cell and B-cell lymphomas often manifest as a rash in their early stages. “When I first was diagnosed with cancer, I had a rash all over my abdominal area,” one MyLymphomaTeam member said. These conditions are a subset of non-Hodgkin lymphoma and are commonly slow growing. Many people with cutaneous lymphomas go years without a correct diagnosis. Unlike many other types of lymphomas, the lymph nodes are rarely affected until late into the condition and are not raised or swollen. Cutaneous T-cell lymphomas make up around 75 percent to 80 percent of all cutaneous lymphomas.

What Does a Lymphoma Rash Feel Like?

Lymphoma rashes can be localized or occur all over the body (also referred to as erythroderma). A cutaneous T-cell lymphoma called mycosis fungoides is responsible for around half of all skin lymphomas. In its early stages, mycosis fungoides is sometimes mistaken for psoriasis or eczema. “I was itching very bad from my neck to my feet. I went to nine different doctors [and] they all misdiagnosed me,” one member reported.

Lymphoma rashes are also called lesions. They are divided into three categories: patches, plaques, and tumors. Patches are flat, smooth, or scaly to the touch and look like a typical rash. Plaques are harder, thicker, and scaly to the touch. Tumors are raised bumps or nodules.

Sézary syndrome (Dermnet NZ)

Sézary syndrome (Dermnet NZ)

Erythrodermic (full-body) rashes are sometimes caused by Sezary syndrome, which makes up 15 percent of cutaneous lymphomas. The rash can feel hot, sore, and itchy. It is usually much more aggressive than mycosis fungoides. Cancerous lymphocytes are present in the blood in Sezary syndrome, but not with mycosis fungoides.

How Does a Rash Affect People With Lymphoma?

Members of MyLymphomaTeam described a variety of ways rashes have affected their lives. “This rash and itching is getting so frustrating. I can’t sleep well,” one MyLymphomaTeam member said. Another mentioned the difficulty a family member had with a rash. “I am always searching for information and ways to ease his pain and itching.” A third member who was reportedly in remission mentioned frustration with a possible recurrence. “I’m so irritated; I have new spots and went to a dermatologist and they tried to tell me that it’s eczema.”

What Causes a Lymphoma Rash?

Cutaneous lymphoma forms in the small number of lymphocytes that are present in the skin. A rash occurs when those lymphocytes mutate, become cancer cells, and grow uncontrollably. It is not considered a skin cancer because the initial source of cancer cells come from the lymphocytes instead of the skin cells themselves.

Skin Treatments for Lymphoma Rashes

Treatment options depend on what type of lymphoma is causing the rash. Most types of cutaneous lymphoma are slow progressing, and some cases never progress past the skin. Because of this, the American Cancer Society’s recommended treatments first target the skin. There are several different types of skin-directed therapies.

Topical Corticosteroids

Topical corticosteroids are the first line of treatment, like with many other skin conditions. The anti-inflammatory agents in them also kill lymphoma cells. They can be creams or ointments applied directly to the skin or injections given directly into affected areas. In addition to treating the rash, topical corticosteroids can decrease itching. Side effects can include skin thinning and hair growth. When used over a long period of time, they can affect the adrenal glands.

Topical Chemotherapy

Topical chemotherapy agents are usually given along with corticosteroids. Mechlorethamine is the most commonly used, and it works by blocking DNA replication in cancer cells. It is applied as a gel to the affected area. When used as a topical solution, it is not known to enter the blood. About 10 percent of those who are treated with Mechlorethamine develop contact dermatitis, a localized allergic reaction.

Another drug, Carmustine, is occasionally used as a supplement to Mechlorethamine. Unlike Mechlorethamine, it can be absorbed into the blood. Monitoring by a dermatologist is needed at higher doses.

Topical Immunotherapy

One commonly used drug is Imiquimod. When it is applied to the skin, it has been shown to clear cutaneous lymphoma lesions.

Retinoids

Retinoids are synthetic vitamin A medications that can cause certain types of cells to die. Retinoids are usually used when topical corticosteroids and chemotherapy agents are not effective. Since they can cause birth defects, women using the drug should not become pregnant.

Phototherapy

Phototherapy uses two types of UV light (A and B) to destroy cancer cells. If UVA light is used in treatment, Psoralen drugs are used in conjunction with it. Psoralens make the skin more sensitive to UV light. UVB does not require any drug administration before treatment, but it is used on thinner lesions only. “I am getting UVB light therapy every Wednesday, but every time I get it, more rashes come out,” a MyLymphomaTeam member said.

Radiation Therapy

Two different types of radiation therapy are commonly used. Total skin electron beam (TSEB) therapy penetrates only a few layers of skin and does not have the severe effects of more invasive radiotherapy. Brachytherapy places radioactive isotopes under the skin for a period of time.

Systemic Treatments for Lymphoma Rashes

If Sezary syndrome is present, skin-based treatments are not used because the condition also affects the blood. Instead, systemic treatments target the whole body. Many of these treatments are similar to skin-based ones.

Interferon

Interferons are cytokine compounds normally produced by cells as a response to disease. Interferons are typically injected three times a week for three to six months.

Retinoids

These are taken as an oral medication and not applied to the skin, but they work the same way as topical ones.

Histone Deacetylase (HDAC) Inhibitors

Histone deacetylase inhibitors work by targeting cells’ DNA in a way that allows cancer cells to die. The most commonly used drugs are vorinostat (Zolinza) and romidepsin (Istodax). Both are given intravenously. One MyLymphomaTeam member described a family member’s treatment with romidepsin, “She went for her initial treatment last Thursday and it seems to be working. Her itching has subsided significantly. Very slight side effects.”

Extracorporeal Photopheresis

Extracorporeal photopheresis takes white blood cells out of a sample of a person’s blood, exposes them to UV light, and puts them back into the bloodstream. The treated cells then act against the cancerous ones.

Antibodies

The most commonly used biologics to treat cutaneous T-cell lymphoma are monoclonal antibodies, which are developed to recognize specific types of cancer cells. Brentuximab vedotin (Adcetris) has been used to treat advanced cutaneous T-cell lymphoma. It works by targeting an antigen found on cancerous T cells.

Chemotherapy

While often used in combination to treat other cancers, chemotherapy agents are often used as “single agents” — one at a time — to treat cutaneous T-cell lymphoma.

Stem Cell Transplant

The only known cure for cutaneous lymphoma is a bone marrow transplant, also known as a stem cell transplant. Since this is a risky procedure, it is typically only done when the condition is very advanced or has come back repeatedly after other treatments.

MyLymphomaTeam Members’ Tips for a Lymphoma Rash

MyLymphomaTeam members have shared a variety of ways of dealing with rash. “You need treatment and creams to deal with the overwhelming itching,” one advised.

Specific topical treatments were mentioned by others:

  • “Use a good skin cream, a steroid cream of 0.05 percent.”
  • “I use a script from my dermatologist: 0.05 steroid cream, and every day I also use a good skin cream.”
  • “Using aloe vera now helps with inflammation and itching.”
  • “Try cannabis oil or cream.”
  • “My doctors at UC Davis in Sacramento and University of California, Sacramento, gave me a prescription of triamcinolone acetonide ointment USP, 0.1 percent. … This medicine took care of the rash.”

Nutritional measures helped ease the rash symptoms for one member. “I juice at times. (I mix carrots, celery, kale/spinach, apple, orange and lemon juices, mixed with berries like blueberries, raspberries, and strawberries; and add some ginger and turmeric). I walk daily (get out in the fresh air) and use an elliptical and weight machines.”

Find Your Team

You are not alone. When you join MyLymphomaTeam, you gain a support network of more than 12,000 people who understand what you’re going through.

Have any questions about rash and lymphoma? Do you have any tips for dealing with a rash? Comment below or start a conversation on MyLymphomaTeam.

Understanding Blood Counts in Leukemia

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Editor’s Note: This resource, Understanding Blood Counts in Leukemia, was originally published by MyHealthTeam.

Key Takeaways

  • Complete blood count (CBC) is a common blood test often performed for people living with leukemia.
  • If a CBC shows high or low numbers of any type of blood cell, this can help doctors better understand how your leukemia and any treatments for leukemia are affecting your body.
  • Anxiety about blood tests and waiting for results is normal, but members of MyLeukemiaTeam offer each other support.

People living with leukemia need numerous blood tests before, during, and after treatment. When you give a blood sample, it may be tested in the laboratory in many different ways. Common blood tests for leukemia include complete blood count (CBC), genetic analysis of cancer cells, and minimal residual disease (MRD) — a measurement of how many leukemia cells remain in the body after treatment.

A CBC is one of the most frequently run tests for people with leukemia. The abbreviations that appear on a CBC results report can be confusing. Here is a breakdown of what is tested for and what CBC results can tell doctors.

Types of Blood Cells

A complete blood count shows the current number of cells in your blood and what types of cells they are. Blood is made of three main types of cells: red blood cells, white blood cells, and platelets.

  • Red cells (RBCs) are also referred to as erythrocytes. Their primary function is to carry oxygen from the heart and lungs to different parts of the body.
  • White cells (WBCs) are also known as leukocytes. They work as a first line of defense in the immune system, fighting bacteria and viruses that may enter the blood.
  • Platelets are also referred to as thrombocytes. They are small cells that gather at sites of injury and help blood clot.

Two other aspects of blood are usually tested in a CBC: hematocrit and hemoglobin. Hematocrit levels measure how much of your blood, by percentage, is currently made up of red cells. Hemoglobin indirectly measures the number of red blood cells in your blood. Hematocrit and hemoglobin help doctors better understand how well your RBCs are functioning at carrying oxygen to the tissues of your body.

Normal Ranges for Blood Count Results

On a CBC, red blood cell levels, white blood cell levels, and platelet levels are typically expressed as the number of cells per microliter of blood. Normal blood counts vary by individual. However, there are general ranges for men, women, and children.

The normal range of red blood cells per microliter is:

  • 4.7 million to 6.1 million for men
  • 4.2 million to 5.4 million for women
  • 4 million to 5.5 million for children

The normal range of white blood cells per microliter is:

  • 5,000 to 10,000 for men
  • 4,500 to 11,000 for women
  • 5,000 to 10,000 for children

Normal ranges for hematocrit levels are:

  • 42 percent to 54 percent of total blood count for men
  • 37 percent to 47 percent for women
  • 32 percent to 44 percent for children

Hemoglobin is expressed in grams per deciliter (gm/dL). Normal ranges for hemoglobin are:

  • 13.5 to 17.5 gm/dL for men
  • 12 to 15.5 gm/dL for women
  • 11 to 13 gm/dL for children

Platelet counts, regardless of age or gender, are considered normal at 150,000 to 400,000 per microliter.

White blood cells are also measured by ratio of WBC types — the white blood cell differential. There are five main types of white blood cells: neutrophils, eosinophils, lymphocytes, monocytes, and basophils. In a normal blood count, the WBC differential comprises:

  • 55 percent to 70 percent neutrophils
  • 20 percent to 40 percent lymphocytes
  • 2 percent to 8 percent monocytes

Basophils and eosinophils make up the remainder.

Abnormal Blood Count Results

Leukemia can affect blood cell counts in various ways, as can many treatments for leukemia — such as chemotherapy and radiation.

What do abnormal results mean? For any given value, a result can be too high, too low, or unusual in relation to another value. For instance, the white blood cell differential may show an abnormal skew in WBC types. Abnormal results can indicate an issue in the bone marrow — where blood cells are made — or a variety of other disease processes. Although normal ranges are an expression of what is normal for the majority of healthy people, those with underlying conditions may have lower or higher ranges that are normal for them. For instance, in people living with heart disease, a higher-than-normal RBC count may be normal.

Your CBC results will help your doctor better understand how your leukemia and leukemia treatments are affecting your body. If results show your risk for serious side effects or complications is rising, your doctor may make a change in your leukemia treatment or prescribe other medications to address the problem.

Anemia

If someone’s RBC, hematocrit, or hemoglobin counts are low, they are considered anemic. Anemia may occur when there are too few red blood cells being made in the bone marrow, or when the red cells are being destroyed by disease. Anemia can also be a consequence of low levels of iron, B12, or folate in the diet, along with other potential causes — including heavy or persistent bleeding. The primary symptoms of anemia are fatigue, weakness, and pale skin.

If your RBC count, hematocrit, or hemoglobin are low, your doctor may order a follow-up blood test called a reticulocyte count. Reticulocytes are immature RBCs. Counting them can help determine whether the problem is reduced RBC production or if the cells are being destroyed.

High Red Blood Cell Count

If red blood cell levels are too high, it may mean there is not enough oxygen in the blood. It can also indicate dehydration. In rare cases, a high RBC count may be due to polycythemia vera, a type of blood cancer in which RBCs are overproduced by the bone marrow. Overly high red blood cell counts are treated by drawing blood until the count is lowered. In some cases, medication might be used to reduce the amount of red cells.

Low Platelet Count

A low platelet count, also referred to as thrombocytopenia, can indicate potential problems with blood clotting. Thrombocytopenia may occur when insufficient numbers of platelets are being made in the bone marrow, or platelets are being destroyed. In some cases, the body does not recognize the platelets as part of one’s normal immune system and attacks them. Symptoms of low platelet count are bruising easily, excessive bleeding from minor cuts and scrapes, and bleeding from the nose or gums.

Transfusion is the most common way of treating low platelets, but your doctor may suggest other methods to reduce the chance of bleeding. If a blood test shows your platelets are low, your doctor may recommend avoiding common non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen, or ibuprofen. These medications can interfere with the blood’s ability to clot.

High Platelet Count

A high platelet count is called thrombocytosis. The two most common causes are a pre-existing condition or a bone marrow abnormality. High platelet counts can lead to stroke, heart attack, or a blood clot in a vein. Thrombocytosis is treated with medications that inhibit platelet production in bone marrow.

Low White Blood Cell Count

An overall low white blood cell count, also called leukopenia, means the body’s ability to fight infection is impaired. If there are fewer neutrophils in white blood cell counts, this is called neutropenia. When neutrophils are low, normal symptoms of infection may not show up, since those symptoms are specifically caused by the reaction of neutrophils fighting infection. This can lead to infections lasting longer and being harder to treat.

Low levels of lymphocytes mean the body cannot detect or fight viral infection as easily as usual, as lymphocytes are the cells that react first to viruses. If a test has shown you have low white counts and you develop a fever, you should seek immediate medical attention, as this may be the first sign of a serious problem.

Both leukemia and leukemia treatments can cause leukopenia.

High White Blood Cell Count

Also known as leukocytosis, a high WBC count is a hallmark of some types of leukemia and other cancers of the bone marrow. High white blood cell counts can also indicate an existing infection or a dysfunction in the immune system.

Pancytopenia

If red cells, white cells, and platelets all have low levels, it is called pancytopenia. Pancytopenia is a sign, not a disease in and of itself. Pancytopenia can be caused by leukemia or other diseases of the bone marrow, a side effect of chemotherapy or radiation treatment, an autoimmune condition, or the result of an infection.

Blood Counts and Leukemia Types

Different types of leukemia can be indicated by different blood test results. Acute lymphocytic leukemia (ALL) may cause a large number of immature white cells (lymphoblasts) in the blood, as well as low numbers of red blood cells and platelets. Acute myeloid leukemia (AML) may cause pancytopenia. In both chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and chronic myeloid leukemia (CML), mature cell counts are closer to normal, resulting in less severe symptoms than in acute leukemias.

Anxiety About Blood Test Results

Blood tests make many people with leukemia nervous. Results may show how well treatment is working or whether side effects from treatments are becoming more severe. “Waiting is the WORST,” one MyLeukemiaTeam member said.

Members have come up with a variety of ways to make the process easier. One member made sure they kept a copy of any results from their tests. “I make sure I have [a] copy of my blood work before I leave the doctor’s office. I keep files on all tests and results from any doctors I see.”

Another MyLeukemiaTeam member advised others to make sure they ask about any blood test results they do not understand. “If you are ever concerned about your numbers, you should discuss them with the doctor and ask him or her to explain it better to you.”

When you join MyLeukemiaTeam, you gain a community of more than 7,000 people living with or caring for someone with leukemia. Blood count tests and results are a frequent topic of conversation.

Do you get anxious when waiting for blood count results? Do you have any tips for dealing with stress around blood tests? Start a conversation on MyLeukemiaTeam.

MyLeukemiaTeam

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MyLeukemiaTeam is a free social network that makes it easy for you to:

  • get the emotional support you need from others like you, and
  • gain practical advice and insights on managing treatment or therapies for leukemia

When you or a loved one are first diagnosed, it’s not uncommon to feel alone and uncertain of where to find the best information and people that can help you now. We believe in making it easy to find the best people around you to help you get the answers you need, and to find support from people who can truly relate. The main currency on our site is trust – the more you share in posts and your stories, the more questions you ask and answer, the more your support will be valued by other members.

MyLeukemiaTeam is the only social network where you can truly connect, make real friendships, and share daily ups and downs in a judgment-free place.

MyLeukemiaTeam

MyMyelomaTeam

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MyMyelomaTeam is a free social network that makes it easy for you to:

  • get the emotional support you need from others like you, and
  • gain practical advice and insights on managing treatment or therapies for myeloma

When you or a loved one are first diagnosed, it’s not uncommon to feel alone and uncertain of where to find the best information and people that can help you now. We believe in making it easy to find the best people around you to help you get the answers you need, and to find support from people who can truly relate. The main currency on our site is trust – the more you share in posts and your stories, the more questions you ask and answer, the more your support will be valued by other members.

MyMyelomaTeam is the only social network where you can truly connect, make real friendships, and share daily ups and downs in a judgment-free place.

Visit MyMyelomaTeam