![]() 1,2 A low percentage of these disorders present without the production of any monoclonal protein. These disorders are commonly characterized by the production of monoclonal proteins which may be either intact immunoglobulins (M-Ig), serum free light chains (sFLC), a combination of both, or rarely, free heavy chains only. Monoclonal Gammopathies (MGs) include premalignant Monoclonal Gammopathies of Uncertain Significance (MGUS), Smoldering/Indolent Multiple Myeloma and malignant conditions. The aim of this article is to provide a clear discrimination between the two assays and to provide information to physicians and laboratory technicians so that they can utilize the International Myeloma Working Group guidelines. Furthermore, we elaborate on our study comparing the two assays used in 11 Light Chain Multiple Myeloma patients at presentation and 103 patients taken through the course of their disease. This paper reviews the available literature comparing the two assays and tries to clarify hypothetical limitations of the total assay to detect Multiple Myeloma. Other assays that measure light chains in the free and intact immunoglobulin forms are sensitive, but unfortunately, due to the nomenclature used, these assays (total light chains) are sometimes used in place of the free light chain assay. The serum free light chain assay recognizes the light chain component of the immunoglobulin in its free form with high sensitivity. Since 2006, the serum free light chain test Freelite ® has been included alongside standard laboratory tests (serum and urine protein electrophoresis, and serum and urine immunofixation) as an aid in the identification of monoclonal proteins, which are a cornerstone for the diagnosis of Multiple Myeloma. However, early diagnosis is associated with less severe disease, including fewer patients presenting with acute renal injury, pathological fractures and severe anemia. The diagnosis of Multiple Myeloma is a challenge to the physician due to the non-specific symptoms (anemia, bone pain and recurrent infections) that are commonplace in the elderly population.
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