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Test ID HLCM Immunoglobulin Heavy and Light Chain (HLC) Pairs, IgM Kappa and IgM Lambda

Useful For

The quantitation of heavy and light chain pairs is useful for:

1. Distinguishing between broadly migrating monoclonal proteins and restricted polyclonal immunoglobulin responses

 

2. Quantitating monoclonal IgM proteins that are difficult to quantitate on serum protein electrophoresis

 

3. Providing a more specific quantitation of the monoclonal protein than quantitating total IgM

Reporting Name

HLC, IgM, S

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Clinical Information

Plasma cell proliferative diseases such as multiple myeloma are defined by the monoclonal expansion of bone marrow plasma cells. The abnormal proliferation of clonal cells in the bone marrow can be identified by a skewed ratio of cells synthesizing kappa or lambda immunoglobulin. In addition, the secreted monoclonal immunoglobulin can usually be identified in serum or urine by protein electrophoresis and immunofixation electrophoresis. These electrophoretic procedures can show restricted immunoglobulin migration, characterize the heavy and/or light chains, and quantitate the monoclonal protein. Some monoclonal proteins, however, are difficult to identify and quantitate by electrophoretic assays. The serum concentration of monoclonal free light chains for example may not be high enough to be recognized or quantitated. Immunoassays that are specific for free light chains, as opposed to light chains bound to heavy chains, can quantitate kappa and lambda free light chains. An abnormal ratio of the free light chains can identify excess clonal plasma cell proliferation and the concentration of the monoclonal free light chain can be determined. Another example of proteins that are difficult to identify and quantitate are monoclonal proteins that are intact immunoglobulins (heavy and light chains) that migrate very broadly in the gamma fraction or migrate within the beta or alpha fractions. Immunoassays that are specific for heavy and light chain pairs (HLC) such as IgM kappa or IgM lambda can quantitate the individual HLC pairs and be used to identify abnormal ratios of the HLC pairs and to quantitate the monoclonal HLC pair.

Reference Values

Total IgM

0-<5 months: 26-122 mg/dL

5-<9 months: 32-132 mg/dL

9-<15 months: 40-143 mg/dL

15-<24 months: 46-152 mg/dL

2-<4 years: 37-184 mg/dL

4-<7 years: 37-224 mg/dL

7-<10 years: 38-251 mg/dL

10-<13 years: 41-255 mg/dL

13-<16 years: 45-244 mg/dL

16-<18 years: 49-201 mg/dL

≥18 years: 37-286 mg/dL

 

IgM kappa: 22-161 mg/dL

IgM lambda: 10-94 mg/dL

MK/ML ratio: 0.7900-4.61

Interpretation

An elevated IgM heavy and light chain (HLC) pair ratio suggests a clonal proliferation of an IgM kappa clone of plasma cells.

 

A low IgM HLC pair ratio suggests a clonal proliferation of an IgM lambda clone of plasma cells.

Clinical Reference

1. Donato LJ, Zeldenrust SR, Murray DL, Katzmann JA: A 71-year-old woman with multiple myeloma status after stem cell transplantation. Clin Chem 2011 Dec;57(12):1645-1648

2. Bradwell AR, Harding SJ, Fourrier NJ, et al: Assessment of monoclonal gammopathies by nephelometric measurement of individual immunoglobulin kappa/lambda ratios. Clin Chem 2009 Sept;55(9):1646-1655

Day(s) and Time(s) Performed

Monday, Thursday

Analytic Time

2 days

CPT Code Information

82784

83883 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HLCM HLC, IgM, S In Process

 

Result ID Test Result Name Result LOINC Value
HLCTM Total IgM, S 2472-9
HLCMK IgM Kappa, S 74866-5
HLCML IgM Lambda, S 74867-3
MKMLR IgM Kappa/Lambda HLC Ratio 74870-7

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

Method Name

Nephelometry 

Includes total immunoglobulin M.