A patient was suspected of having a lymphoproliferative disorder. Which sequence of laboratory tests should be performed first?

A patient was suspected of having a lymphoproliferative disorder. Which sequence of laboratory tests should be performed first?

• A. Serum protein electrophoresis (SPE) followed by immunofixation electrophoresis (IFE)
• B. Immunoglobulin levels followed by SPE
• C. Total lymphocyte count followed by immunoglobulin levels
• D. Immunoglobulin levels followed by urine protein electrophoresis

Answer: (A)

When assessing a patient for a lymphoproliferative disorder, the sequence of laboratory tests is critical for an accurate diagnosis. Performing serum protein electrophoresis (SPE) first allows for the identification of monoclonal proteins, which are indicative of disorders such as multiple myeloma or certain lymphomas. SPE provides a snapshot of the protein composition in serum, and the presence of a monoclonal spike (M-protein) is a key marker of lymphoproliferative conditions. Following SPE with immunofixation electrophoresis (IFE) is essential because IFE can further characterize the specific type of immunoglobulin involved in the monoclonal spike, allowing for a more definitive diagnosis. This two-step process is standard practice because it provides both a preliminary assessment and a more detailed analysis of possible abnormal immunoglobulin production. The other options presented do not prioritize the most informative tests for initial evaluation. For instance, while immunoglobulin levels are helpful, they do not provide the same immediate insight into the presence of monoclonal proteins as SPE does. Similarly, total lymphocyte counts and urine protein electrophoresis do not focus on the specific abnormalities characterized by lymphoproliferative disorders as effectively as the combined approach of

When assessing a patient for a lymphoproliferative disorder, the sequence of laboratory tests is critical for an accurate diagnosis. Performing serum protein electrophoresis (SPE) first allows for the identification of monoclonal proteins, which are indicative of disorders such as multiple myeloma or certain lymphomas. SPE provides a snapshot of the protein composition in serum, and the presence of a monoclonal spike (M-protein) is a key marker of lymphoproliferative conditions.

Following SPE with immunofixation electrophoresis (IFE) is essential because IFE can further characterize the specific type of immunoglobulin involved in the monoclonal spike, allowing for a more definitive diagnosis. This two-step process is standard practice because it provides both a preliminary assessment and a more detailed analysis of possible abnormal immunoglobulin production.

The other options presented do not prioritize the most informative tests for initial evaluation. For instance, while immunoglobulin levels are helpful, they do not provide the same immediate insight into the presence of monoclonal proteins as SPE does. Similarly, total lymphocyte counts and urine protein electrophoresis do not focus on the specific abnormalities characterized by lymphoproliferative disorders as effectively as the combined approach of