Malignancy

This section deals with clinical conditions associated with malignancy which are covered by the Immunology department. For each clinical condition, the relevant immunological tests are listed together with a short explanation of their use.

Flow cytometry is a useful aid to the diagnosis of leukaemias and lymphomas. Cells from blood, marrow or fresh lymph node can be studied. Flow cytometry works when:

• The sample is fresh (<12 hours old)
• There are clear clinical details
• Marrow samples should be placed in special medium, available from the laboratory
• Lymph node biopsies should not be formalin fixed

Flow cytometry may also be used to assess whether Leukaemia or lymphoma has gone into remission after chemotherapy. Finally, flow cytometry can be used to measure the number of circulating stem cells prior to stem cell transplantation.

See BCSH Guidelines for more information and guidelines.

The demonstration of paraproteins by electrophoresis is one of the criteria required for a diagnosis of multiple myeloma. Their quantification, the degree of associated immunosuppression of other immunoglobulins and the excessive proliferation of plasma cells in the bone marrow are all laboratory indicators of a malignant paraproteinaemia.

Serum levels of β2-microglobulin are useful indicators of prognosis, partly reflecting the degree of renal damage (and are raised in other causes of renal failure, malignancies, and some autoimmune disorders). Serum free light chain estimation is a useful adjunct to the diagnosis and monitoring of myeloma.

Lymphoproliferative disorders

This section deals with the clinical condition lymphoproliferative disorders, listing the relevant immunological tests, together with a short explanation of their use.

Relevant immunological tests:

• Immunophenotyping for lymphoid and myeloid malignancies
• Chronic lymphocytic/lymphoma panel
• Acute Leukaemia panel
• CD34 (Stem cells)

Patient information

Patient information is available from:

• Leukaemia Research Fund
• Lymphoma Association

Paraproteinaemia

This section deals with the clinical condition paraproteinaemia, listing the relevant immunological tests, together with a short explanation of their use.

Relevant immunological tests:

• Serum protein electrophoresis/densitometry: Immunoglobulins (IgG, IgA, IgM), Free Light Chains
• Urinary Light Chains: Bence Jones protein
• Immunofixation: Uses electrophoresis sample
• β2-microglobulin: β2 Microglobulin

Patient information is available from International Myeloma Federation (UK).

 

(Last reviewed June 2019)