From the Guidelines
Elevated alpha-1, alpha-2, beta-1, and beta-2 proteins on serum protein electrophoresis (SPEP) along with anemia suggests an inflammatory or reactive process, and the most appropriate next step is to assess the degree of inflammation and characterize the anemia with a complete blood count, iron studies, and reticulocyte count, as recommended by the British Society of Gastroenterology guidelines 1. The pattern of elevated alpha-1, alpha-2, beta-1, and beta-2 proteins is commonly seen in acute or chronic inflammation, infection, tissue damage, or malignancy.
- The elevated acute phase reactants (alpha-1 and alpha-2 globulins) reflect hepatic production of proteins like alpha-1-antitrypsin, haptoglobin, and ceruloplasmin in response to inflammatory cytokines.
- The beta region elevations may represent increased complement proteins, transferrin, or other transport proteins. Further workup should include:
- Iron studies, including serum ferritin, transferrin saturation, and total iron-binding capacity, to diagnose iron deficiency anemia, as serum ferritin is the most specific test for iron deficiency in the absence of inflammation 1.
- Vitamin B12 and folate levels to rule out deficiency anemia.
- Reticulocyte count to assess bone marrow response to anemia. Depending on clinical presentation, additional testing may include:
- Blood cultures if infection is suspected.
- Protein immunofixation to rule out monoclonal gammopathies. Treatment should target the underlying cause rather than the protein abnormalities themselves, and once the underlying condition is addressed, these protein abnormalities typically normalize, and the anemia should improve, as indicated by the European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases 1.
From the Research
Elevated Alpha 1 Alpha 2 Beta 1 Beta 2 Serum Protein Electrophoresis and Anemia
- Elevated alpha 1 alpha 2 beta 1 beta 2 serum protein electrophoresis can be an indicator of various conditions, including inflammation, malignancies, and liver or renal failure 2.
- Anemia can be caused by iron deficiency, which can be detected through serum ferritin levels and complete blood count (CBC) parameters 3, 4, 5.
- The diagnosis of iron deficiency anemia can be challenging, and the use of CBC parameters, such as mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular hemoglobin (MCH), can be helpful in discriminating iron deficiency anemia 3.
- Serum protein electrophoresis can be a useful tool in the diagnosis of anemia, particularly in cases where the cause is unclear 2.
- The interpretation of biochemical and haematological findings in iron deficiency anemia can be complex, and the use of ferritin measurement, transferrin receptor levels, and other markers can be helpful in determining the cause of anemia 5, 6.
Diagnostic Approaches
- Complete blood count (CBC) parameters, such as RBC count, hematocrit, MCV, MCHC, and MCH, can be used to diagnose iron deficiency anemia 3.
- Serum ferritin levels can be used to detect iron deficiency, but the diagnostic cut-off value can vary 5.
- Serum protein electrophoresis can be used to identify patients with multiple myeloma and other serum protein disorders 2.
- Other diagnostic tests, such as peripheral blood smear, reticulocyte count, and iron panel, can be used to evaluate anemia 4.