When is serum protein electrophoresis (SPEP) indicated?

Updated: Jul 31, 2019
  • Author: Sherilyn Alvaran Tuazon, MD; Chief Editor: Eric B Staros, MD  more...
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Serum protein electrophoresis is generally considered in any patient with an elevated total protein, especially those with elevated globulin level relative to albumin, or any signs and symptoms suggestive of an underlying plasma cell disorder such as multiple myeloma, Waldenstrom’s macroglobulinemia, or primary amyloidosis. [5] These include any of the following:

  • Unexplained anemia, back pain, bone pain, fatigue

  • Unexplained pathologic fracture or lytic lesions

  • Unexplained peripheral neuropathy

  • Hypercalcemia secondary to possible malignancy

  • Hypergammaglobulinemia

  • Rouleaux formation noted on peripheral blood smear

  • Renal insufficiency with bland urine sediment

  • Unexplained proteinuria

  • Bence Jones proteinuria

  • Recurrent infections

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