The Pattern of Immunoglobulin Production in Secretory Myeloma and the Relationship Between Relevant Hematological and Clinical Parameters in Basrah
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Keywords
Plasma cell disorders, Multiple myeloma, Serum protein electrophoresis.
Abstract
Background: Plasma cell disorders encompass a spectrum of diseases ranging from benign to malignant. Among malignant plasma cell disorders, multiple myeloma is the most common and well-recognized entity. Aim: To identify the pattern of immunoglobulin production in secretory myeloma in Basra and correlate findings with hematological and clinical data. Methods: A retrospective study of 143 patients with plasma cell disorders was conducted at the Department of Pathology, Basrah Oncology Center, Iraq. Clinical data, relevant laboratory parameters (erythrocyte sedimentation rate, renal function tests, and serum calcium), bone marrow examination findings, radiological findings of bony lesions, and results from serum/urine protein electrophoresis and immunofixation or flow cytometric immunophenotyping were analyzed in conjunction with medical records. Results: Abnormal urine protein electrophoresis was found in 93.4% of patients, with most M bands located in the gamma region. The most prevalent subtype was IgG kappa, accounting for 68% of cases. This was followed by IgG lambda (17%), IgM lambda (6.5%), IgM kappa (3.2%), IgA kappa (1.3%), and free light chains (1.3%). Laboratory parameters showed wide variability, with a median hemoglobin of 9.1 g/dL, serum calcium of 9.9 mg/dL, and erythrocyte sedimentation rate of 80 mm/hr. Significant associations were found between immunofixation electrophoresis subtypes and erythrocyte sedimentation rate, serum calcium, and urea. Notably, the IgA kappa group had higher serum calcium (mean 12.45 mg/dL, p = 0.020). Radiological findings revealed multiple bony lesions in the majority of patients. Conclusions: Serum protein electrophoresis is a useful initial screening tool for detecting paraproteinemia, but it lacks sensitivity for accurately characterizing monoclonal proteins. Immunofixation, by contrast, provides higher sensitivity and allows precise identification of monoclonal immunoglobulin subtypes. In our cohort, IgG kappa was the predominant subtype, aligning with global trends, whereas patients with the IgA isotype exhibited more severe laboratory abnormalities.
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