Details of the eight educational interpretive comments attached to test reports: targeted laboratory tests, educational interpretive comments, and cues
| Test | Action cue | Brief educational message |
|---|---|---|
| ELE | Raised alpha-1 and alpha-2 globulins | Pattern may be consistent with low-grade inflammation |
| IgG | Diffusely raised IgG | Pattern of persistent infection or inflammation |
| IgG, IgA | Diffusely raised IgG and IgA | Polyclonally raised IgG and IgA: pattern of persistent infection or inflammation |
| IgA, IgG, IgM | IgA deficiency (IgA must be <0.1 g/l with a normal IgG and IgM with a normal pattern) | Normal electrophoretic pattern but very low total IgA concentration: would be consistent with IgA deficiency. This is seen in approximately 1/500 of the population and often without clinical consequence |
| IgM | Raised IgM with a normal electrophoresis | Patient has a slightly raised IgM. If antimitochondrial antibodies are negative, this may be consistent with recent infection, particularly viral. If antimitochondrial antibodies are positive, this may be consistent with primary biliary cirrhosis |
| IgA, ELE | Raised IgA with a normal electrophoresis | Normal electrophoresis pattern with a slightly raised IgA: may be consistent with mucosal inflammation, autoimmune illnesses, or liver disease |
| IgM | Low IgM in an older patient (>70 years) with normal electrophoresis | Slightly low IgM: this may be an incidental finding, particularly in older patients, but it may also be an indicator of some secondary immune suppression |
| Interpretive comment for when a paraprotein is present | ||
| PARA | If a faint band is present | Serum shows a small paraprotein with normal background gamma. This pattern could be an incidental finding in a patient of this age or may be seen secondary to recent infection. However, urine must be checked for Bence Jones protein and suggest recheck serum in 3–4 months to assess any progression. If you do have strong clinical indications, for example, hypercalcaemia, renal impairment, anaemia, bone pain, etc., suggest investigate further |
ELE = serum protein electrophoresis. IgA = immunoglobulin A. IgG = immunoglobulin G. IgM = immunoglobulin M. PARA = paraprotein.