Dysproteinemia

Dysproteinemia is a medical term used to describe abnormal levels or distributions of serum proteins. It typically refers to changes detected in serum protein electrophoresis or quantitative immunoglobulin measurements, and can involve either quantitative abnormalities (hypoproteinemia or hyperproteinemia) or qualitative abnormalities (the presence of abnormal immunoglobulins). In practice, the term often denotes an abnormal immunoglobulin fraction, such as a monoclonal protein, but it can also describe imbalances in the major protein fractions produced by the liver and immune system.

Common causes include monoclonal gammopathies such as multiple myeloma, Waldenström macroglobulinemia, and monoclonal gammopathy of undetermined significance, as well as polyclonal gammopathies seen in chronic infections or inflammatory diseases. Other etiologies encompass liver disease, nephrotic syndrome, autoimmune conditions, HIV infection, malnutrition, and certain medications. Dysproteinemias may be incidental findings on laboratory testing or may reflect clinically significant disease requiring further evaluation.

Diagnosis hinges on protein studies and interpretation of the pattern of findings. Initial testing typically includes total serum protein, albumin, and globulin fractions, followed by serum protein electrophoresis to identify abnormal bands or spikes. If a monoclonal spike is detected, immunofixation electrophoresis is used to characterize the type of monoclonal protein. Quantitative immunoglobulin measurements, urine protein electrophoresis (for Bence Jones proteins), and assessment of organ involvement may follow. In cases of suspected plasma cell disorders, bone marrow examination and imaging studies may be indicated.

Management targets the underlying cause. Some dysproteinemias are monitored without immediate treatment, while others require specific therapies directed at plasma cell disorders, liver or kidney disease, or inflammatory conditions. Regular follow-up is important to detect progression or resolution.