Immunofixation Electrophoresis, Blood and Urine


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Immunofixation Electrophoresis, Blood and Urine

Synonym/acronym: IFE.

Common use

To identify the individual types of immunoglobulins, toward diagnosing diseases such as multiple myeloma, and to evaluate effectiveness of chemotherapy.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum in a standard transport tube within 2 hr of collection. Urine (10 mL) from a random or timed collection in a clean plastic container.

Normal findings

(Method: Immunoprecipitation combined with electrophoresis) Test results are interpreted by a pathologist. Normal placement and intensity of staining provide information about the immunoglobulin bands.

Description

Immunofixation electrophoresis (IFE) is a qualitative technique that provides a detailed separation of individual immunoglobulins according to their electrical charges followed by the application of specific antiserum (anti-IgM, anti kappa, etc.) and a stain, to help visualize the patterns. It is usually requested when there is an abnormality in the gamma globulin fraction of a serum protein electrophoresis; either monoclonal or polyclonal. IFE is frequently used to identify the three main immunoglobulin groups (IgG, IgM, and IgA) and the light chain proteins (kappa and lambda). Antisera for IgE and IgD are available for use, if indicated. Abnormalities are revealed by changes produced in the individual bands, such as displacement compared to a normal pattern, intense color which reflects an increase, or absence of color which reflects a decrease. Urine IFE has replaced the Bence Jones screening test for light chains. IFE has replaced immunoelectrophoresis because it is more sensitive and easier to interpret. IFE is used to help detect, diagnose, and monitor the course and treatment of conditions like kidney disease, multiple myeloma and Waldenström’s macroglobulinemia.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the diagnosis of multiple myeloma and amyloidosis
  • Assist in the diagnosis of suspected immunodeficiency
  • Assist in the diagnosis of suspected immunoproliferative disorders, such as multiple myeloma and Waldenström’s macroglobulinemia
  • Identify biclonal or monoclonal gammopathies
  • Identify cryoglobulinemia
  • Monitor the effectiveness of chemotherapy or radiation therapy

Potential diagnosis

See the “Immunoglobulins A, D, G, and M” and “Protein, total and fractions” studies.

Critical findings

    N/A

Interfering factors

  • Drugs that may increase immunoglobulin levels include asparaginase, cimetidine, and narcotics.
  • Drugs that may decrease immunoglobulin levels include dextran, oral contraceptives, methylprednisolone (high doses), and phenytoin.
  • Chemotherapy and radiation treatments may alter the width of the bands and make interpretation difficult.

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Powerlessness (Related chronic illness; treatment for illness; loss of ability to provide self-care; progressive debilitation; terminal prognosis)Expression of loss of control over situation, self, outcome of disease; passive; apathetic; submissive; decreased participation in self-care; reluctant to express feelingsAssess need to be in control; assess feelings of hopelessness, depression, apathy; assist to identify situations that contribute to a feeling of powerlessness; assess the impact of the sense of powerlessness on the patient’s sense of self; encourage verbalization of feelings; discuss therapeutic options offered by health-care provider (HCP); assist to identify strengths; identify coping strategies; encourage being responsible for self-care and personal environment to increase sense of control; give positive feedback
Hopelessness (Related to chronic illness; impaired functionality; prolonged pain and discomfort)Decreased affect; decreased response to stimuli; feeling of emptiness; alterations in sleep patterns and appetite; expressions of apathy; withdrawn; states life has no meaningAssess role of illness in relation to expressions of helplessness; assess grooming (energy to provide good personal hygiene); assess level of appetite; assess verbalization of helplessness; provide opportunities to express feelings in a safe environment; support development of a trusting relationship to decrease feelings of isolation; encourage verbalization of personal strengths and weaknesses; encourage realistic hope; assist in identification of coping skills
Mobility (Related to pain; weakness; depression; fatigue; decreased muscle strength; decreased coordination)Decreased purposeful movement; difficulty completing activities of daily living; limited range of motion; reluctance to move; painAssess the patient’s ability to perform independent range-of-motion exercises; encourage performance of range-of-motion exercises; encourage and assist in moving every 2 hr to relieve tissue pressure; assist with activities of daily living; encourage use of assistive devices as needed to support mobility
Protection (Related to failure of bone marrow; replacement of bone marrow by neoplastic cells; insufficient autoimmune response; chemotherapy; bone marrow transplant)Bleeding; infection; anemiaMonitor and trend HGB/HCT; monitor and trend platelets and red blood cells (RBCs); monitor for symptoms of infection; take temperature every 4 hr; institute bleeding precautions, soft toothbrushes, avoid aspirin, avoid IM or IV injections, coordinate laboratory draws to minimize venipuncture; administer prescribed steroids, erythropoietin; administer prescribed blood and blood products; avoid at-risk activities that could cause trauma; discuss exposure to microbes that could result in infection

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in assessing the immune system.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s hematopoietic and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results. Assess whether the patient received any vaccinations or immunizations within the last 6 mo or any blood or blood components within the last 6 wk.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Provide a nonmetallic urinal, bedpan, or toilet-mounted collection device.
  • Note that usually a 24-hr time frame for urine collection is ordered. Inform the patient that all urine must be saved during that 24-hr period. Instruct the patient not to void directly into the laboratory collection container. Instruct the patient to avoid defecating in the collection device and to keep toilet tissue out of the collection device to prevent contamination of the specimen. Place a sign in the bathroom to remind the patient to save all urine.
  • Instruct the patient to void all urine into the collection device and then to pour the urine into the laboratory collection container. Alternatively the specimen can be left in the collection device for a health-care staff member to add to the laboratory collection container.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture as appropriate.
  • Blood

  • Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Urine

  • Clean-Catch Specimen
  • Instruct the male patient to (1) thoroughly wash his hands, (2) cleanse the meatus, (3) void a small amount into the toilet, and (4) void directly into the specimen container.
  • Instruct the female patient to (1) thoroughly wash her hands; (2) cleanse the labia from front to back; (3) while keeping the labia separated, void a small amount into the toilet; and (4) without interrupting the urine stream, void directly into the specimen container.
  • Blood or Urine

  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
  • Patient Education

    • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
    • Answer any questions or address any concerns voiced by the patient or family.
    • Provide contact information for support groups.
  • Expected Patient Outcomes

    • Knowledge
    • States understanding of the importance of ambulation to prevent demineralization and support bone health
    • States understanding of the importance of using assistive devices to support mobility and decrease injury risk.
    • Skills
    • Strictly avoids at-risk activities that could result in trauma and bleeding
    • Makes dietary selections that include omitting fresh fruit to decrease exposure to bacteria
    • Attitude
    • Adheres to recommended therapeutic regime
    • Makes a positive effort to address feelings of hopelessness and powerlessness

Related Monographs

  • Related tests include anion gap, biopsy bone, biopsy bone marrow, biopsy liver, biopsy lymph node, cold agglutinin, CBC, CBC WBC count and differential, cryoglobulin, ESR, fibrinogen, quantitative immunoglobulin levels, LAP, liver and spleen scan, β-2-microglobulin, platelet antibodies, protein total and fractions, and UA.
  • Refer to the Hematopoietic and Immune systems tables at the end of the book for related tests by body system.
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