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Immunoglobulines monoclonales : méthodes diagnostiques en 2011. (French)
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- Author(s): Beauvillain, Céline; Jeannin, Pascale; Renier, Gilles; Chevailler, Alain
- Source:
Revue Francophone des Laboratoires; Jun2011, Vol. 2011 Issue 433, p55-62, 8p- Subject Terms:
- Source:
- Additional Information
- Alternate Title: Monoclonal gammopathies: biological diagnosis in 2011 (English)
- Abstract: Summary: A monoclonal gammopathy is charaterized by a selective increase of a single serum immunoglobulin due to an only dysregulated clone of B lymphocytes. This monoclonal component is composed of either only one heavy and one light chains, or of isolated light chains of only one isotype, or in particular instances of fragmented heavy chains of only one isotype. Monoclonal immunoglobulins may arise apart from malignancies. The demonstration and characterization of monoclonal immunoglobulins needs a linked serum and urine analysis. Detection of monoclonal component will not be done by a sole biological test, but by combining in different maners some of these listed methods: agarose gel electrophoresis, immunoelectrophoresis and/or immunofixation, capillary electrophoresis with immunosubstraction, immunoselection, quantification of immunoglobulins and of free light chains and characterization of cryoglobulinemia. The analysis of the results leading to the diagnosis of monoclonal immunoglobulin is still a matter of difficulty because in some clinical occurrences (light chain myeloma, cryoglobulinemia,…) the available methods have to be performed in the right order. A skillful methodological and biological experience is needed to conduct the right sequence of biological tests always after full knowledge of the patient''s clinical status. [Copyright &y& Elsevier]
- Abstract: Résumé: Une immunoglobuline monoclonale se caractérise par l’augmentation sélective d’une seule espèce moléculaire d’immunoglobuline sérique, causée par la prolifération incontrôlée d’un clone unique de lymphocytes B, constituée soit d’une seule classe de chaîne lourde et d’un seul type de chaîne légère, soit de chaînes légères isolées d’un seul type, soit beaucoup plus rarement de fragments de chaînes lourdes d’une seule classe. Sa présence n’est pas systématiquement synonyme de malignité. Le diagnostic biologique d’une immunoglobuline monoclonale repose sur la réalisation d’une analyse conjointe du sérum et des urines qui vise à affirmer son homogénéité de charge et d’isotypie. Le diagnostic biologique de gammapathie monoclonale ne se limite pas à un seul dosage, mais dépend d’une stratégie raisonnée, utilisant les différents outils diagnostiques que sont l’électrophorèse, qu’elle soit sur gel ou capillaire, l’immunoélectrophorèse ou immunofixation, l’immunosélection, les dosages d’immunoglobulines et de leurs chaînes légères libres, et enfin la recherche de cryoglobuline. L’interprétation des résultats menant au diagnostic d’immunoglobuline monoclonale reste encore source de difficultés, car certaines situations cliniques (myélome à chaînes légères, cryoglobulinémie, …) nécessitent de combiner de manière judicieuse l’ensemble des techniques mises à disposition. Une grande expertise technique et biologique est donc requise pour, au vu des renseignements cliniques indispensables, choisir au mieux la séquence des examens, et ainsi assurer la qualité et l’efficacité de la stratégie mise en œuvre.
- Abstract:
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