Abstract
Serum free light chain estimations entered most clinical laboratory test menus from September 2008. Their main clinical utility is in the identification of persons who might have a light chain only plasma cell dyscrasia. Other reasons clinicians request these assays are for the monitoring of persons with myeloma and monitoring progression of renal impairment. Increased sensitivity for detection of excessive free light chain production over urine protein electrophoresis and immunofixation may earlier identify persons with AL amyloid or myeloma. Non-compliance by patients with requests for urine EPG-IFE can be offset by serum free light chain estimations. Serum free light chain assays are unable to define clonality in a person with abnormal free light chain levels unlike serum or urine protein electrophoresis. Measurements can be insensitive to prozone effects, potentially underestimating light chain levels despite careful testing strategies. Some monoclonal free light chain bands may have idiosyncratic charge and other physical characteristics that can frustrate good assay systems. Physician responses to abnormal results may vary according to clinical context in terms of known monoclonal bands, renal impairment, suspicion of AL amyloid, immunosuppressive treatments. Robust and reliable serum free light chains have earned a mature role in serum protein studies with strong support by clinician users.
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