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Test Code FHLCG Immunoglobulin G (IgG) Heavy and Light Chain (HLC) Pairs, Kappa and Lambda with Ratio


Specimen Required


Specimen Type: Serum

Container/Tube:  Red top or SST

Specimen Volume: 0.75 mL

Collection Instructions: Draw blood in a plain red-top tube, serum gel tube(s) is also acceptable. Separate serum immediately after coagulation (30 minutes) to prevent hemolysis. Send 0.75 mL of serum refrigerated in a plastic vial.

 

NOTE: Patient should be fasting for eight hours to avoid lipemic sample interference.


Secondary ID

75551

Useful For

Heavy and light chain pair quantitation may be useful for:

1. Distinguishing between broadly migrating monoclonal proteins and restricted polyclonal immunoglobulin patterns on serum electrophoresis. 

2. Quantitating monoclonal IgG proteins that are difficult to quantitate using serum protein electrophoresis alone.

3. Providing a more specific quantitation of the monoclonal protein than total IgG measurements alone.

Method Name

Turbidimetric

Reporting Name

IgG Heavy Light Chains (HLC), S

Specimen Type

Serum

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Ambient  14 days
  Frozen  14 days

Reject Due To

Hemolysis Mild reject; Gross reject
Lipemia Mild reject; Gross reject
Icterus NA
Other Microbially-contaminated specimen; specimen containing particulate matter

Clinical Information

Elevated serum concentrations of monoclonal protein are indicative of an underlying abnormality, such as monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma, and other lymphoproliferative disorders. International guidelines recommend serum protein electrophoresis or nephelometric immunoglobulin quantification as tools to monitor patients' disease (alongside other tests including flow cytometry and serum free light chain analysis). Total IgG nephelometric assays will include nontumor immunoglobulin, and measurement of either IgG Kappa or IgG Lambda may give a more accurate representation of tumor production.

 

Furthermore, measurement of both IgG Kappa and IgG Lambda, calculation of the IgG Kappa:IgG Lambda ratio, and comparison with values found in normal subjects can give a more sensitive indication of clonality. Additionally, changes in the IgG Kappa:IgG Lambda ratio and its normalization when compared to a normal ratio range should assist in monitoring patients' disease. Use of the IgG Kappa:IgG Lambda ratio will also compensate for any changes in plasma volume and correct for half life variations due to receptor saturation.

Reference Values

IgG Kappa (g/L): 4.03 - 9.78

IgG Lambda (g/L): 1.97 - 5.71

IgG Kappa:IgG Lambda ratio: 0.98 - 2.75

Interpretation

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

A low IgG HLC pair ratio suggests a clonal proliferation of an IgG Lambda clone of plasma cells.

Day(s) Performed

Tuesday, Friday

Performing Laboratory

LabCorp Burlington

CPT Code Information

83883 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
FHLCG IgG Heavy Light Chains (HLC), S 74773-3

 

Result ID Test Result Name Result LOINC Value
Z5613 IgG Kappa, S 74862-4
Z5614 IgG Lambda, S 74863-2
Z5615 IgG K/L HLC Ratio 74868-1

Specimen Minimum Volume

0.5 mL