The Fellow on Call: The Heme/Onc Podcast Episode 140: Myeloma Series, Pt.1 - Intro to Testing and MGUS (2025)
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Dec 3, 2025 Delve into the fascinating world of plasma cell dyscrasias! The conversation kicks off with the biology of plasma cells, touching on the role of immunoglobulins. Explore why SPEP referrals are common and the significance of monitoring monoclonal proteins. Learn about MGUS, its prevalence, and associated risks. Discover when a bone marrow biopsy is necessary and the effectiveness of modern imaging techniques. The hosts outline essential testing protocols to navigate this complex landscape!
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What Plasma Cells Do And Why Clones Matter
- Plasma cells produce antibodies as part of humoral immunity and normally make a diverse set of immunoglobulins.
- A clonal plasma cell chooses one heavy and one light chain, causing a monoclonal protein that can drive disease.
Case: 73-Year-Old With Incidental M Spike
- Dan Hausrat shared a case of a 73-year-old man with normocytic anemia whose SPEP showed an M-spike of 1.2 g/dL.
- The case illustrates a common real-world referral pattern for incidental monoclonal proteins found during anemia workup.
How SPEP Reveals An M Spike
- SPEP (serum protein electrophoresis) separates serum proteins by size and shows peaks like albumin and gamma region.
- A sharp monoclonal 'M spike' in the gamma region indicates clonal identical immunoglobulin production and can be quantified.