A finding of an M-spike on SPEP raises suspicion for which conditions?

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Multiple Choice

A finding of an M-spike on SPEP raises suspicion for which conditions?

A monoclonal protein detected as an M-spike on serum protein electrophoresis signals a clonal plasma cell process. This pattern is the hallmark of plasma cell dyscrasias, most notably multiple myeloma and MGUS. In multiple myeloma, a sizeable clone of plasma cells produces a single class of immunoglobulin (the M-protein), which can be associated with organ damage summarized as CRAB (hypercalcemia, renal impairment, anemia, bone lesions). MGUS is a precursor state with a small M-protein and no CRAB features, but it can progress to multiple myeloma. Other conditions like iron deficiency anemia, diabetic nephropathy–related CKD, or acute hepatitis do not create a discrete monoclonal spike; they typically show polyclonal changes or non-spike patterns on SPEP. When an M-spike is found, follow-up with immunofixation to identify the specific monoclonal immunoglobulin type, quantitative immunoglobulins, and often bone marrow examination to assess for an underlying plasma cell disorder.

A monoclonal protein detected as an M-spike on serum protein electrophoresis signals a clonal plasma cell process. This pattern is the hallmark of plasma cell dyscrasias, most notably multiple myeloma and MGUS. In multiple myeloma, a sizeable clone of plasma cells produces a single class of immunoglobulin (the M-protein), which can be associated with organ damage summarized as CRAB (hypercalcemia, renal impairment, anemia, bone lesions). MGUS is a precursor state with a small M-protein and no CRAB features, but it can progress to multiple myeloma. Other conditions like iron deficiency anemia, diabetic nephropathy–related CKD, or acute hepatitis do not create a discrete monoclonal spike; they typically show polyclonal changes or non-spike patterns on SPEP. When an M-spike is found, follow-up with immunofixation to identify the specific monoclonal immunoglobulin type, quantitative immunoglobulins, and often bone marrow examination to assess for an underlying plasma cell disorder.

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