# Serum Protein Fractions in Veterinary Biochemistry ## Quick Answer - Serum protein electrophoresis separates total protein into albumin and globulin fractions, providing pattern recognition that total protein and albumin/globulin ratios cannot offer for differential diagnosis. - Pursue electrophoresis when total protein is persistently elevated, when physical examination reveals unexplained weight loss or lymphadenopathy, or when routine biochemistry suggests a paraproteinemia. - Electrophoresis identifies but does not diagnose disease, interpretation requires correlation with complete blood count, biochemistry panel, urinalysis, and clinical findings. ## Understanding Serum Protein Fractions in Veterinary Biochemistry Serum protein electrophoresis is a laboratory technique that separates serum proteins based on their electrical charge and molecular size when placed in an electric field. The resulting pattern, called an electropherogram, displays distinct bands or peaks that correspond to albumin and the alpha, beta, and gamma globulin fractions. Each fraction contains multiple proteins with overlapping functions, and changes in these fractions reflect specific pathophysiologic processes. Total protein measurement and the albumin/globulin ratio are commonly included in routine biochemistry panels, but these values provide only a summary of the protein composition. When the total protein is abnormal or the albumin/globulin ratio is reversed, the clinician cannot determine which specific protein fraction is responsible. Serum protein electrophoresis resolves this limitation by separating the protein components and allowing the laboratory professional to identify whether the abnormality involves albumin, one of the globulin fractions, or multiple fractions simultaneously. The veterinary diagnostic approach begins with recognizing when protein electrophoresis is indicated. Routine biochemistry panels that show hyperproteinemia, hypoproteinemia, or an abnormal albumin/globulin ratio should prompt consideration of this test. Clinical signs such as chronic weight loss, unexplained fever, lymphadenopathy, or a palpable abdominal mass may also warrant electrophoretic evaluation even when the total protein is within the reference interval. The American Veterinary Medical Association provides general pet-owner education about preventive care and the importance of regular veterinary examinations, which include routine blood work that may identify protein abnormalities requiring further investigation. The American Animal Hospital Association offers practice guidance for companion-animal preventive care that supports the use of diagnostic testing when clinical findings suggest underlying disease ([AAHA Guidelines](https://www.aaha.org/resources)). ## The Electrophoretic Fractions and Their Protein Composition ### Albumin Albumin is the most abundant protein in the serum of most domestic species. It is synthesized exclusively by the liver and has a relatively small molecular weight compared to the globulins. Albumin functions as a transport protein for hormones, fatty acids, bilirubin, and drugs, and it contributes approximately 75 to 80 percent of the colloid osmotic pressure of plasma. The albumin fraction appears as a single, sharp, well-defined band on the electropherogram. Because albumin is synthesized by the liver, decreased albumin concentration reflects either decreased production or increased loss. Decreased production occurs in advanced liver disease, malnutrition, or chronic inflammatory states that suppress hepatic protein synthesis. Increased loss occurs through the kidneys in glomerular disease, through the gastrointestinal tract in protein-losing enteropathy, or through the skin in severe exudative lesions. Hypoalbuminemia is a common finding in chronic disease and is associated with a poor prognosis in many conditions. The magnitude of the decrease provides useful clinical information, but the cause requires further investigation. The Merck Veterinary Manual provides authoritative background on the diagnostic approach to hypoalbuminemia and the diseases that produce it ([Merck Veterinary Manual](https://www.merckvetmanual.com/)). ### Alpha Globulins The alpha globulin fraction is divided into alpha-1 and alpha-2 subfractions in some species. Alpha-1 globulins include alpha-1 antitrypsin and alpha-1 acid glycoprotein, which are acute phase proteins. Alpha-2 globulins include haptoglobin, ceruloplasmin, and alpha-2 macroglobulin. The alpha globulin fraction increases in response to acute inflammation. These proteins are synthesized by the liver in response to inflammatory cytokines, and their concentration rises within hours to days after the onset of inflammation. The alpha globulin fraction may also increase in response to tissue necrosis or neoplasia. The alpha globulin fraction is less commonly evaluated in isolation than the gamma globulin fraction. However, an increase in the alpha globulin fraction can provide evidence of an acute inflammatory response when the total protein is normal and the albumin/globulin ratio is not informative. ### Beta Globulins The beta globulin fraction contains transferrin, complement components, and beta-lipoprotein. Transferrin is the iron transport protein, and complement components are part of the innate immune system. The beta globulin fraction may also contain immunoglobulin A in some species. The beta globulin fraction increases in response to chronic inflammation and in some cases of neoplasia. The beta-gamma bridging pattern, in which the beta and gamma fractions merge into a single broad band, is a classic finding in chronic inflammatory disease, particularly in chronic liver disease. ### Gamma Globulins The gamma globulin fraction contains the immunoglobulins, which are the antibodies produced by plasma cells. The gamma globulin fraction is the most clinically informative fraction on the electropigram because it reflects the humoral immune response. The gamma globulin fraction can be increased in two distinct patterns. A polyclonal gammopathy appears as a broad, diffuse increase in the gamma globulin region and reflects the activation of many different plasma cell clones. This pattern is seen in chronic inflammation, infection, and immune-mediated disease. A monoclonal gammopathy appears as a narrow, sharp spike or peak in the gamma region, reflecting the proliferation of a single clone of plasma cells. This pattern is characteristic of multiple myeloma and other plasma cell neoplasms. The distinction between polyclonal and monoclonal gammopathy is the most important clinical decision that protein electrophoresis supports. The pattern determines the differential diagnosis and the subsequent diagnostic workup. ## When to Pursue Serum Protein Electrophoresis The decision to pursue serum protein electrophoresis is based on the combination of clinical findings and routine laboratory abnormalities. The following situations should prompt consideration of this test. ### Hyperproteinemia Hyperproteinemia is defined as a total protein concentration above the reference interval for the species. The first step in evaluating hyperproteinemia is to determine whether the increase is due to hemoconcentration or to an actual increase in protein concentration. Hemoconcentration is caused by dehydration and is characterized by proportionate increases in albumin and globulin concentrations. The albumin/globulin ratio remains normal. If the hyperproteinemia is not due to hemoconcentration, the increase is usually due to an increase in the globulin fraction. The albumin/globulin ratio is typically decreased. The next step is to determine whether the globulin increase is polyclonal or monoclonal, which requires protein electrophoresis. ### Hypoproteinemia Hypoproteinemia is defined as a total protein concentration below the reference interval. Hypoproteinemia is usually due to a decrease in albumin, because albumin is the most abundant protein. The causes of hypoalbuminemia include decreased production in liver disease, increased loss through the kidneys or gastrointestinal tract, and sequestration in body cavities. The albumin/globulin ratio is typically decreased in hypoproteinemia, but the ratio does not distinguish between the causes. Protein electrophoresis can help determine whether the globulin fraction is normal, decreased, or increased, which narrows the differential diagnosis. ### Reversed Albumin/Globulin Ratio A reversed albumin/globulin ratio is defined as a ratio below the reference interval. This finding indicates that the globulin fraction is increased relative to the albumin fraction. The reversal can be due to an increase in globulins, a decrease in albumin, or both. The reversed ratio is a nonspecific finding that occurs in many diseases. Protein electrophoresis is required to determine whether the globulin increase is polyclonal or monoclonal, and whether the albumin decrease is proportionate to the globulin increase. ### Clinical Signs Suggestive of Paraproteinemia Certain clinical signs should prompt consideration of protein electrophoresis even when the total protein is normal. These signs include unexplained weight loss, chronic fever, lymphadenopathy, bone pain, and bleeding disorders. The presence of a monoclonal gammopathy should be considered in any patient with these signs, particularly in older animals. The World Small Animal Veterinary Association provides global guidelines for companion-animal clinical practice that emphasize the importance of a thorough diagnostic workup when clinical signs suggest underlying disease ([Global Guidelines](https://wsava.org/global-guidelines)). ## The Electrophoresis Procedure Serum protein electrophoresis is performed on a serum sample, not a plasma sample. The sample is collected in a plain tube without anticoagulant and allowed to clot. The serum is then separated by centrifugation and applied to a support medium, such as agarose gel or cellulose acetate. The support medium is placed in an electric field, and the proteins migrate according to their charge. Albumin has the most negative charge and migrates the farthest toward the anode. The globulins migrate more slowly, and the gamma globulins migrate the least because they have the least negative charge. After the proteins have migrated, the support medium is stained with a protein-binding dye. The intensity of the stain is proportional to the protein concentration. The stained pattern is then scanned by a densitometer, which produces a graph with peaks corresponding to the protein fractions. The densitometer calculates the relative percentage of each fraction, and the absolute concentration of each fraction is calculated by multiplying the percentage by the total protein concentration. The results are reported as the absolute concentration of each fraction and the relative percentage of each fraction. The quality of the result depends on the quality of the sample. Hemolyzed, lipemic, or icteric samples can interfere with the interpretation. The sample should be collected and processed according to the laboratory protocol. ## Interpreting the Electrophoretic Pattern The interpretation of the electrophoretic pattern requires a systematic approach. The first step is to evaluate the albumin fraction. The second step is to evaluate the globulin fractions, particularly the gamma globulin fraction. The third step is to correlate the pattern with the clinical findings. ### Normal Pattern The normal electrophoretic pattern varies by species. The albumin fraction is the largest and appears as a sharp, well-defined band. The alpha, beta, and gamma globulin fractions appear as smaller, less distinct bands. The gamma globulin fraction is typically the smallest of the globulin fractions. The reference intervals for each fraction vary by species and by laboratory. The interpretation should always be based on the reference interval provided by the laboratory that performed the test. ### Polyclonal Gammopathy A polyclonal gammopathy appears as a broad, diffuse increase in the gamma globulin region. The band is wide and the peak is not sharp. This pattern reflects the activation of multiple plasma cell clones and is seen in chronic inflammation, infection, and immune-mediated disease. The polyclonal pattern is a nonspecific finding. It does not identify the specific cause of the inflammation or infection. The clinician must use the clinical findings and other laboratory tests to determine the underlying cause. ### Monoclonal Gammopathy A monoclonal gammopathy appears as a narrow, sharp spike or peak within the gamma globulin region. The peak is tall and narrow, and the surrounding gamma globulin is often decreased. This pattern reflects the proliferation of a single clone of plasma cells, which produces a single type of immunoglobulin. The monoclonal pattern is characteristic of multiple myeloma and other plasma cell neoplasms. The diagnosis of myeloma requires additional testing, including bone marrow evaluation and imaging. ### Beta-Gamma Bridging Beta-gamma bridging is a pattern in which the beta and gamma globulin fractions merge into a single, broad band. This pattern is seen in chronic inflammatory disease, particularly in chronic liver disease. The pattern is not specific for a single disease, but it is a useful clue when combined with other findings. ### Hypogammaglobulinemia Hypogammaglobulinemia is a decrease in the gamma globulin fraction. This pattern is seen in primary immunodeficiency, in which the animal cannot produce antibodies, and in secondary immunodeficiency, in which the immune system is suppressed. ## At a Glance | Electrophoretic Pattern | Appearance | Common Causes | Clinical Significance | | --- | --- | --- | --- | | Polyclonal gammopathy | Broad, diffuse increase in gamma region | Chronic inflammation, infection, immune-mediated disease | Indicates active humoral immune response, requires further diagnostic workup | | Monoclonal gammopathy | Narrow, sharp peak in gamma region | Multiple myeloma, plasma cell neoplasia | Strongly suggests neoplastic plasma cell proliferation, requires bone marrow evaluation | | Beta-gamma bridging | Merging of beta and gamma regions | Chronic liver disease, chronic inflammation | Supports chronic inflammatory process, often with hepatic involvement | | Hypogammaglobulinemia | Decreased gamma region | Primary or secondary immunodeficiency | Indicates impaired antibody production, requires immune function evaluation | ## Correlation with Clinical Findings The electrophoretic pattern must be interpreted in the context of the complete clinical picture. The pattern alone does not provide a diagnosis. The clinician must integrate the electrophoretic results with the history, physical examination findings, complete blood count, biochemistry panel, urinalysis, and other diagnostic tests. ### Complete Blood Count The complete blood count provides information about the red blood cells, white blood cells, and platelets. In a patient with a polyclonal gammopathy, the complete blood count may reveal anemia of chronic disease, which is a normocytic, normochromic anemia. In a patient with a monoclonal gammopathy, the complete blood count may reveal anemia, leukopenia, or thrombocytopenia due to bone marrow infiltration. ### Biochemistry Panel The biochemistry panel provides information about the liver, kidneys, and other organs. In a patient with a polyclonal gammopathy, the biochemistry panel may reveal evidence of chronic liver disease, such as increased liver enzymes or decreased albumin. In a patient with a monoclonal gammopathy, the biochemistry panel may reveal hypercalcemia, which is a common finding in multiple myeloma. ### Urinalysis The urinalysis provides information about the kidneys and the urinary tract. In a patient with a monoclonal gammopathy, the urinalysis may reveal proteinuria, which is due to the excretion of the monoclonal protein through the kidneys. The urine protein electrophoresis can be used to detect the Bence Jones protein, which is the light chain of the immunoglobulin. ### Imaging Imaging studies, such as radiography and ultrasonography, can be used to evaluate the organs and detect masses. In a patient with a monoclonal gammopathy, imaging may reveal lytic bone lesions, which are characteristic of multiple myeloma. ## Common Failure Patterns The interpretation of the electrophoretic pattern can be complicated by several factors. The clinician and the laboratory professional should be aware of these potential pitfalls. ### Hemolysis Hemolysis is the breakdown of red blood cells, which releases hemoglobin into the serum. Hemoglobin migrates in the beta globulin region and can interfere with the interpretation of the beta globulin fraction. The sample should be collected and processed to minimize hemolysis. ### Lipemia Lipemia is the presence of excess lipids in the blood. Lipemia can cause the serum to appear cloudy or milky, and it can interfere with the densitometric scanning. The sample should be collected after a fast to minimize lipemia. ### Icterus Icterus is the presence of bilirubin in the blood. Bilirubin can interfere with the densitometric scanning, particularly in the beta globulin region. The sample should be collected and processed to minimize icterus. ### Sample Quality The quality of the sample is critical for the accuracy of the result. The sample should be collected in the correct tube, processed promptly, and stored appropriately. The sample should not be hemolyzed, lipemic, or icteric. ## Practical Workflow for the Clinician The following workflow provides a systematic approach to the evaluation of the patient with a protein abnormality. ### Step 1: Confirm the Total Protein Abnormality The first step is to confirm the total protein abnormality. The total protein should be measured on a fresh sample, and the result should be interpreted in the context of the patient's hydration status. If the patient is dehydrated, the total protein may be falsely elevated. ### Step 2: Evaluate the Albumin and Globulin Fractions The second step is to evaluate the albumin and globulin fractions. The albumin concentration and the globulin concentration should be calculated from the total protein and the albumin/globulin ratio. The albumin/globulin ratio should be calculated. ### Step 3: Determine the Need for Electrophoresis The third step is to determine whether protein electrophoresis is indicated. The test is indicated when the total protein is elevated, the albumin/globulin ratio is reversed, or the clinical signs suggest a paraproteinemia. ### Step 4: Interpret the Electrophoretic Pattern The fourth step is to interpret the electrophoretic pattern. The pattern should be evaluated for the presence of a polyclonal or monoclonal gammopathy. The pattern should be correlated with the clinical findings. ### Step 5: Pursue the Differential Diagnosis The fifth step is to pursue the differential diagnosis. The differential diagnosis is based on the electrophoretic pattern and the clinical findings. The clinician should order additional tests to confirm the diagnosis. ### Step 6: Escalate to a Specialist The sixth step is to escalate to a specialist when the diagnosis is unclear or the patient is unstable. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. ## Records and Measurements The following records and measurements should be maintained for the patient with a protein abnormality. ### The Electrophoretic Report The electrophoretic report should include the total protein concentration, the absolute concentration of each fraction, and the relative percentage of each fraction. The report should also include the reference intervals for the species and the laboratory. ### The Clinical Record The clinical record should include the patient's signalment, history, physical examination findings, and the results of the diagnostic tests. The record should document the clinical signs, the differential diagnosis, and the treatment plan. ### The Follow-Up Record The follow-up record should document the patient's response to treatment. The electrophoretic pattern should be repeated to monitor the response to treatment. The pattern should be compared to the baseline pattern. ## Common Failure Patterns The following are common failure patterns in the evaluation of the patient with a protein abnormality. ### Failure to Pursue Electrophoresis The most common failure is the failure to pursue protein electrophoresis when it is indicated. The clinician may rely on the total protein and the albumin/globulin ratio, which are nonspecific. The clinician should pursue the test when the total protein is elevated or the albumin/globulin ratio is reversed. ### Failure to Interpret the Pattern The second common failure is the failure to interpret the electrophoretic pattern correctly. The clinician may misinterpret a polyclonal gammopathy as a monoclonal gammopathy, or vice versa. The clinician should be familiar with the appearance of the patterns. ### Failure to Correlate with Clinical Findings The third common failure is the failure to correlate the electrophoretic pattern with the clinical findings. The pattern alone does not provide a diagnosis. The clinician must integrate the pattern with the complete clinical picture. ### Failure to Pursue the Differential Diagnosis The fourth common failure is the failure to pursue the differential diagnosis. The clinician may stop after the electrophoretic pattern is obtained, without pursuing the additional tests needed to confirm the diagnosis. ## Welfare and Safety Context The welfare of the patient is the primary concern in the diagnostic workup. The blood sample for protein electrophoresis is a routine procedure that is associated with minimal risk. The sample should be collected by a trained professional using aseptic technique. The World Organisation for Animal Health provides official guidance on animal health and welfare, emphasizing the importance of humane handling and the use of diagnostic tests to improve animal health ([Animal Health and Welfare](https://www.woah.org/en/what-we-do/animal-health-and-welfare)). The Cornell University College of Veterinary Medicine provides educational resources for veterinary professionals and pet owners, emphasizing the importance of evidence-based diagnostic testing ([Cornell University College of Veterinary Medicine](https://www.vet.cornell.edu/)). ## Professional Escalation Criteria The following are the criteria for escalation to a specialist. ### Urgent Escalation The patient should be escalated to a specialist immediately if the patient is unstable, has a severe anemia, or has a severe hypercalcemia. The patient should also be escalated if the patient has a suspected plasma cell neoplasm and requires a bone marrow evaluation. ### Routine Escalation The patient should be escalated to a specialist on a routine basis if the electrophoretic pattern is unclear or if the patient is not responding to treatment. The specialist can provide a more detailed interpretation of the pattern and can recommend additional diagnostic tests. ## A Decision Framework for Serial Electrophoresis Monitoring and Treatment Response Assessment Protein electrophoresis is often treated as a one-time diagnostic test, but its greater clinical value emerges when it is used serially to monitor disease progression and treatment response. A single electrophoretic pattern provides a snapshot, while sequential patterns provide a trajectory. This distinction matters because the clinician who only interprets a single result misses the opportunity to detect early treatment failure, disease relapse, or complications such as the development of a monoclonal gammopathy in a patient previously showing a polyclonal pattern. ### The Case for Serial Electrophoresis The decision to repeat protein electrophoresis should be made at the time the initial test is ordered. Waiting until the patient deteriorates clinically before repeating the test loses valuable lead time. The serial approach is particularly important in three clinical scenarios. The first scenario is the patient with a confirmed monoclonal gammopathy. Multiple myeloma and other plasma cell neoplasms require ongoing monitoring to assess the response to chemotherapy. The monoclonal protein concentration is a tumor marker, and its change over time reflects the tumor burden. A decreasing spike indicates a response to treatment, while a stable or increasing spike indicates resistance or relapse. The second scenario is the patient with a polyclonal gammopathy of unknown cause. The polyclonal pattern is nonspecific, and the underlying disease may evolve over time. A repeat electrophoretic pattern can reveal a transition from a polyclonal to a monoclonal pattern, which changes the differential diagnosis and the treatment plan. The third scenario is the patient with a protein-losing condition, such as protein-losing nephropathy or protein-losing enteropathy. The electrophoretic pattern can be used to monitor the response to treatment and to detect the development of complications, such as a hypercoagulable state. The American Animal Hospital Association provides practice guidance for companion-animal preventive care that supports the use of serial diagnostic testing to monitor chronic disease and to assess the response to treatment ([AAHA Guidelines](https://www.aaha.org/resources)). The World Small Animal Veterinary Association offers global guidelines for companion-animal clinical practice that emphasize the importance of monitoring chronic disease and adjusting treatment based on objective measurements ([Global Guidelines](https://wsava.org/global-guidelines)). ### The Serial Electrophoresis Decision Framework The following framework provides a systematic approach to the use of serial protein electrophoresis in clinical practice. The framework is based on the principle that the frequency of testing is determined by the clinical scenario, the treatment protocol, and the stability of the patient. #### Step 1: Establish the Baseline Pattern The first step is to establish a baseline electrophoretic pattern. The baseline pattern is the initial pattern obtained at the time of diagnosis. The baseline pattern should be stored in the patient record and used for comparison with all subsequent patterns. The baseline pattern should include the total protein concentration, the absolute concentration of each fraction, and the relative percentage of each fraction. The baseline pattern should also include a description of the pattern, such as polyclonal, monoclonal, or beta-gamma bridging. #### Step 2: Define the Monitoring Interval The monitoring interval is the frequency with which the electrophoretic pattern is repeated. The interval is determined by the clinical scenario and the treatment plan. For a patient with a confirmed multiple myeloma, the monitoring interval is typically every three to four weeks during the initial treatment phase. The interval may be extended to every 8 to 12 weeks once the patient is in remission. The interval is shortened if the patient is not responding to treatment or if the clinical signs are worsening. For a patient with a polyclonal gammopathy of unknown cause, the monitoring interval is typically every 8 to 12 weeks. The interval is shortened if the clinical signs are worsening or if the total protein is increasing. For a patient with a protein-losing condition, the monitoring interval is determined by the severity of the condition and the response to treatment. The interval is typically every 4 to 8 weeks. #### Step 3: Compare the Pattern to the Baseline The serial pattern is compared to the baseline pattern. The comparison should include the total protein concentration, the absolute concentration of each fraction, and the relative percentage of each fraction. The comparison should also include a description of the pattern. The following changes are clinically significant: - An increase in the monoclonal protein concentration of more than 25 percent from the baseline. - A decrease in the monoclonal protein concentration of more than 50 percent from the baseline. - A transition from a polyclonal to a monoclonal pattern. - A decrease in the albumin concentration of more than 20 percent from the baseline. - An increase in the gamma globulin fraction of more than 50 percent from the baseline. #### Step 4: Correlate with Clinical Findings The serial pattern is correlated with the clinical findings. The clinical findings include the physical examination, the complete blood count, the biochemistry panel, and the urinalysis. The correlation is used to determine whether the change in the pattern is clinically significant. For example, a decrease in the monoclonal protein concentration is a favorable finding if the patient is also improving clinically. A decrease in the monoclonal protein concentration is a less favorable finding if the patient is not improving clinically. #### Step 5: Adjust the Treatment Plan The treatment plan is adjusted based on the serial pattern and the clinical findings. The adjustment may include a change in the drug, a change in the dose, or a change in the frequency of the treatment. The treatment plan should be adjusted in consultation with a veterinary internal medicine specialist or a veterinary oncologist. The specialist can provide guidance on the interpretation of the serial pattern and the adjustment of the treatment. #### Step 6: Document the Findings The findings are documented in the clinical record. The record should include the date of the test, the results of the test, the comparison to the baseline, and the clinical correlation. The record should also include the treatment plan and the monitoring interval. ### The Record System for Serial Electrophoresis The record system for serial electrophoresis is a structured method for tracking the results of the test over time. The record system should be used for all patients who are undergoing serial electrophoresis. The record system should include the following components: - The patient identification, including the signalment and the medical record number. - The date of each test. - The total protein concentration. - The absolute concentration of each fraction. - The relative percentage of each fraction. - The description of the pattern. - The clinical findings at the time of the test. - The treatment at the time of the test. - The interpretation of the test. - The action taken based on the test. The record system can be maintained in a spreadsheet or a database. The record system should be reviewed at each visit to determine the trend in the electrophoretic pattern. The following table provides an example of a record system for a patient with a monoclonal gammopathy: | Date | Total Protein | Albumin | Alpha-1 | Alpha-2 | Beta | Gamma | Pattern | Clinical Findings | Treatment | Action | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 01/15 | 9.8 | 2.1 | 0.4 | 1.2 | 1.5 | 4.6 | Monoclonal | Weight loss, lymphadenopathy | Melphalan, prednisone | | 02/12 | 8.5 | 2.3 | 0.4 | 1.1 | 1.4 | 3.3 | Monoclonal | Improved appetite | Melphalan, prednisone | | 03/12 | 7.9 | 2.5 | 0.4 | 1.0 | 1.3 | 2.7 | Monoclonal | Stable | Melphalan, prednisone | | 04/09 | 8.2 | 2.4 | 0.4 | 1.1 | 1.4 | 2.9 | Monoclonal | Recurrence of lethargy | Melphalan, prednisone | The record system allows the clinician to see the trend in the monoclonal protein concentration. The trend is used to determine the response to treatment and to adjust the treatment plan. ### Troubleshooting the Serial Electrophoresis Monitoring The following are common problems that occur in the serial monitoring of the electrophoretic pattern and the methods to address them. #### Problem 1: The Pattern Is Not Reproducible The pattern may not be reproducible if the sample is collected or processed incorrectly. The sample should be collected in a plain tube without anticoagulant and allowed to clot. The serum should be separated by centrifugation and applied to the support medium. The sample should not be hemolyzed, lipemic, or icteric. If the pattern is not reproducible, the clinician should repeat the test on a fresh sample. The clinician should also verify that the laboratory is using the same method and the same reference intervals. #### Problem 2: The Pattern Does Not Match the Clinical Findings The pattern may not match the clinical findings if the patient has a disease that is not reflected in the electrophoretic pattern. The pattern may also not match the clinical findings if the patient has a complication, such as an infection or a bleeding disorder. If the pattern does not match the clinical findings, the clinician should repeat the test and should pursue additional diagnostic tests. The clinician should also consider the possibility of a laboratory error. #### Problem 3: The Pattern Is Not Changing The pattern may not change if the patient is not responding to the treatment. The pattern may also not change if the patient is in a stable phase of the disease. If the pattern is not changing, the clinician should consider the possibility that the treatment is not effective. The clinician should also consider the possibility that the patient is in a stable phase of the disease and that the treatment is maintaining the stability. #### Problem 4: The Pattern Is Changing in an Unexpected Way The pattern may change in an unexpected way, such as a transition from a polyclonal to a monoclonal pattern. The pattern may also change in an unexpected way if the patient develops a new disease. If the pattern is changing in an unexpected way, the clinician should pursue additional diagnostic tests. The clinician should also consider the possibility of a new disease. ### Comparison of the Serial Electrophoresis with Other Monitoring Methods The serial electrophoresis is one of several methods for monitoring the patient with a protein abnormality. The other methods include the total protein, the albumin/globulin ratio, and the serum protein electrophoresis. The total protein is a simple and inexpensive test, but it is not specific. The total protein does not distinguish between the albumin and the globulin fractions. The total protein is not useful for monitoring the response to treatment. The albumin/globulin ratio is a more specific test than the total protein, but it is still not specific. The ratio does not distinguish between the polyclonal and the monoclonal gammopathy. The ratio is not useful for monitoring the response to treatment. The serum protein electrophoresis is the most specific test for monitoring the protein abnormality. The test provides the absolute concentration of each fraction and the pattern. The test is useful for monitoring the response to treatment. The serial electrophoresis is the most useful method for monitoring the patient with a protein abnormality. The serial electrophoresis provides the trend in the protein concentration and the pattern. The trend is used to determine the response to treatment and to adjust the treatment plan. ### The Role of the Veterinary Technician in Serial Electrophoresis The veterinary technician plays a critical role in the serial electrophoresis monitoring. The technician is responsible for the collection of the sample, the preparation of the sample, and the submission of the sample to the laboratory. The technician is also responsible for the documentation of the results and the communication of the results to the clinician. The technician should be trained in the proper collection and handling of the sample. The technician should also be trained in the interpretation of the electrophoretic pattern. The technician should be able to identify the common patterns and to recognize the changes in the pattern. The technician should also be responsible for the maintenance of the record system. The technician should ensure that the record system is accurate and up to date. The technician should also ensure that the record system is accessible to the clinician. ### The Role of the Laboratory in Serial Electrophoresis The laboratory is responsible for the performance of the test and the reporting of the results. The laboratory should use a validated method for the test. The laboratory should also use the same method and the same reference intervals for all the tests. The laboratory should report the results in a clear and concise manner. The report should include the total protein concentration, the absolute concentration of each fraction, and the relative percentage of each fraction. The report should also include the reference intervals for the species and the laboratory. The laboratory should also provide the interpretation of the pattern. The interpretation should be based on the reference intervals and the clinical findings. The interpretation should be provided by a qualified professional. ### The Role of the Specialist in Serial Electrophoresis The specialist is responsible for the interpretation of the serial electrophoretic pattern and the management of the patient. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The specialist should be consulted when the pattern is unclear or when the patient is not responding to the treatment. The specialist should also be consulted when the patient has a suspected plasma cell neoplasm and requires a bone marrow evaluation. The specialist can provide a more detailed interpretation of the pattern and can recommend additional diagnostic tests. The specialist can also provide guidance on the treatment of the patient. ### The Cost of Serial Electrophoresis The cost of serial electrophoresis is a consideration for the client. The cost of the test varies by the laboratory and the species. The cost of the test is typically higher than the cost of the total protein and the albumin/globulin ratio. The clinician should discuss the cost of the test with the client before the test is ordered. The clinician should also discuss the frequency of the test and the expected duration of the monitoring. The clinician should also consider the cost of the test in the context of the overall cost of the treatment. The cost of the test is a small fraction of the cost of the treatment for a patient with a plasma cell neoplasm. ### The Limitations of Serial Electrophoresis The serial electrophoresis has several limitations. The test is not specific for a single disease. The test is not a substitute for the clinical evaluation. The test is not a substitute for the other diagnostic tests. The test is also limited by the quality of the sample. The test is limited by the quality of the laboratory. The test is limited by the interpretation of the pattern. The test is also limited by the cost. The test is not available in all laboratories. The test is not available in all the settings. The clinician should be aware of the limitations of the test and should use the test in the context of the clinical evaluation. ### The Future of Serial Electrophoresis The future of serial electrophoresis is likely to include the use of new technologies. The new technologies may include the use of mass spectrometry and the use of the immunoassay. The new technologies may provide a more detailed analysis of the protein fractions. The new technologies may also provide a more rapid analysis of the protein fractions. The new technologies may also provide a more cost-effective analysis of the protein fractions. The future of serial electrophoresis is also likely to include the use of the point-of-care testing. The point-of-care testing may allow the clinician to perform the test in the clinic. The point-of-care testing may also allow the clinician to obtain the results more quickly. The future of serial electrophoresis is likely to improve the management of the patient with a protein abnormality. The future technologies will provide a more accurate and a more cost-effective method for the monitoring of the patient. ### The Clinical Decision to Stop Serial Electrophoresis The decision to stop serial electrophoresis is based on the clinical findings and the treatment plan. The serial electrophoresis is stopped when the patient is in a stable phase of the disease and the treatment is no longer being changed. The serial electrophoresis is also stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial electrophoresis is also stopped when the client decides to stop the treatment. The decision to stop the serial electrophoresis should be made in consultation with the client and the specialist. The decision should be documented in the medical record. ### The Clinical Decision to Resume Serial Electrophoresis The serial electrophoresis is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient develops a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial electrophoresis is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the use of a more frequent testing or the use of a more detailed analysis. The escalation may also include the use of a specialist. The specialist may provide a more detailed interpretation of the pattern and the management of the patient. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the reduction in the frequency of the testing. The de-escalation may also include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Escalate the Serial Electrophoresis The serial is escalated when the patient is not responding to the treatment or when the patient is unstable. The escalation may include the change to a more invasive or a more advanced testing. The escalation may also include the use of a specialist. The specialist may be a veterinary internal medicine specialist or a veterinary oncologist. The decision to escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to De-escalate the Serial Electrophoresis The serial is de-escalated when the patient is in a stable phase of the disease and the treatment is no longer being changed. The de-escalation may include the change to a less invasive or a less advanced testing. The de-escalation may also include the change to the total protein or the albumin/globulin ratio. The de-escalation may also include the change to the frequency of the testing. The decision to de-escalate the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Stop the Serial Electrophoresis The serial is stopped when the patient is in a terminal phase of the disease and the treatment is no longer being changed. The serial is also stopped when the client decides to stop the treatment. The decision to stop the serial is based on the clinical findings and the treatment plan. The decision should be made in consultation with the client and the specialist. ### The Clinical Decision to Resume the Serial Electrophoresis The serial is resumed when the patient is in a relapse or when the patient is not responding to the treatment. The serial is also resumed when the patient is a new disease. The decision to resume the serial is based on ## Frequently Asked Questions ### What is the difference between a polyclonal and a monoclonal gammopathy? A polyclonal gammopathy appears as a broad, diffuse increase in the gamma globulin region and reflects the activation of multiple plasma cell clones. A monoclonal gammopathy appears as a narrow, sharp peak and reflects the proliferation of a single clone of plasma cells. ### When should I order serum protein electrophoresis? Order the test when the total protein is elevated, the albumin/globulin ratio is reversed, or the clinical signs suggest a paraproteinemia. The test is also indicated when the routine biochemistry panel suggests a protein abnormality. ### What does a low albumin concentration indicate? A low albumin concentration indicates decreased production by the liver, increased loss through the kidneys or gastrointestinal tract, or sequestration in a body cavity. The cause is determined by the clinical picture and other laboratory tests. ### Can serum protein electrophoresis be performed on a plasma sample? The test should be performed on a serum sample, not a plasma sample. The plasma sample contains fibrinogen, which can interfere with the interpretation of the beta globulin fraction. ### What is the beta-gamma bridging pattern? The beta-gamma bridging pattern is a merging of the beta and gamma globulin fractions into a single, broad band. The pattern is seen in chronic inflammation, particularly in chronic liver disease. ### How is the electrophoretic pattern used to monitor treatment? The electrophoretic pattern can be repeated to assess the response to treatment. The pattern should be compared to the previous pattern to determine whether the protein abnormality is improving, worsening, or stable. ### What are the limitations of serum protein electrophoresis? The test is a diagnostic tool that provides a pattern, not a diagnosis. The pattern must be interpreted in the context of the clinical findings. The test cannot determine the specific cause of the protein abnormality. ### What is the role of the veterinarian in the diagnostic workup? The veterinarian is responsible for the clinical evaluation, the interpretation of the laboratory results, and the development of the diagnostic plan. The veterinarian should pursue the test when it is indicated and should interpret the pattern in the context of the clinical picture. ## Related Veterinary Guides - [Serum Biochemistry Interpretation: A Problem-Oriented Approach](/knowledge/veterinary-medicine/clinical-pathology/serum-biochemistry-interpretation-problem-oriented) - [Monitoring Serum Protein Electrophoresis in Chronic Inflammatory Diseases](/knowledge/veterinary-medicine/clinical-pathology/monitoring-serum-protein-electrophoresis-chronic-inflammatory-diseases) - [Clinical Pathology: Hematology and Biochemistry Interpretation](/knowledge/veterinary-medicine/veterinary-pathology-microbiology/clinical-pathology-hematology-and-biochemistry-interpretation) - [Veterinary Drug Compounding Regulations: What Clinicians Must Know](/knowledge/veterinary-medicine/clinical-pharmacology/veterinary-drug-compounding-regulations-clinicians-must-know) - [Tabby Cat: Everything You Need to Know About Patterns, Breeds & Temperament](/knowledge/veterinary-medicine/preventive-care/tabby-cat-breeds-care) ## References and Further Reading - [Pet Care](https://www.avma.org/resources-tools/pet-owners). American Veterinary Medical Association. - [AAHA Guidelines](https://www.aaha.org/resources). American Animal Hospital Association. - [Global Guidelines](https://wsava.org/global-guidelines). World Small Animal Veterinary Association. - [Merck Veterinary Manual](https://www.merckvetmanual.com/). Merck Veterinary Manual. - [Cornell University College of Veterinary Medicine](https://www.vet.cornell.edu/). Cornell University. - [Animal Health and Welfare](https://www.woah.org/en/what-we-do/animal-health-and-welfare). World Organisation for Animal Health. - [Cerebrospinal fluid analysis.](https://pubmed.ncbi.nlm.nih.gov/1641918). The Veterinary clinics of North America. Small animal practice, 1992. - [The diagnostic utility of serum protein electrophoresis.](https://pubmed.ncbi.nlm.nih.gov/11229047). The veterinary clinics of North America. Exotic animal practice, 1999. - [Protein Electrophoresis of Serum and Heparinized Plasma in the Common Mynah (Acridotheres tristis).](https://pubmed.ncbi.nlm.nih.gov/34677029). Journal of avian medicine and surgery, 2021. - [Serum Protein Concentration and Serum Protein Fractions in Bottlenose Dolphins (Tursiops truncatus) under Human Care Using Agarose Gel Electrophoresis.](https://pubmed.ncbi.nlm.nih.gov/37889653). Animals : an open access journal from MDPI, 2023. - [Evaluation of serum protein electrophoresis and immunofixation in dogs seropositive for various vector-borne pathogens.](https://pubmed.ncbi.nlm.nih.gov/39528734). Veterinary clinical pathology, 2024. > This article is educational and is not a substitute for veterinary diagnosis or treatment. Contact a veterinarian for advice about an individual animal.