Bone marrow biopsy revealed 8% plasma cells that were polyclonal by flow cytometry. Serum IFX showed a biclonal gammopathy (monoclonal IgG kappa (κ) and IgG lambda (λ)). A repeat SPEP was interpreted as a monoclonal (M) spike of 6.1 g/dL. Laboratory evaluation revealed iron deficiency anemia with hemoglobin of 9.1 g/dL (normal, 12 to 15.5 g/dL). Patient 1: A 30-year-old female with a past medical history of rheumatoid arthritis, vasculitis and MGUS presented to our institution with fatigue. 4 Herein, we describe four patients with hypergammaglobulinemia ascribed to a pseudo-monoclonal gammopathy diagnosed by traditional methods, but were found to have polyclonal hypergammaglobulinemia using MS. This is based on the fact that these immunoglobulins secreted from clonal plasma cells have a unique amino acid sequence and, consequently, a unique molecular mass. Recent publications have shown that mass spectrometry (MS) can be used to monitor the monoclonal protein with higher accuracy compared to traditional methods (SPEP/IFX/FLC). Therefore, it is critical to have a reliable method to differentiate between these two conditions. 1– 3 Once a monoclonal protein is detected, an extensive workup including bone marrow biopsy may be necessary. In contrast, monoclonal gammopathy is diagnosed based on the appearance of relatively restricted bands on SPEP or serum immunofixation (IFX) or by abnormal serum immunoglobulin free light chain (FLC) ratios and is associated with malignant (i.e., multiple myeloma) or premalignant (i.e., monoclonal gammopathy of undetermined significance (MGUS)) disease. ![]() Polyclonal hypergammaglobulinemia is usually associated with inflammatory conditions and detected on serum protein electrophoresis (SPEP) as broad indistinct band. Hypergammaglobulinemia can result from both polyclonal and monoclonal immunoglobulin production.
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