Kappa And Lambda- Freelite chain quantitative assay

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Measures immunoglobulin light chains.

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Kappa And Lambda- Freelite Chain Quantitative Assay

Why is it done?
- Test Measurement: Measures free immunoglobulin light chains (kappa and lambda) in serum and urine to detect monoclonal protein disorders and plasma cell abnormalities
- Primary Indications: Diagnosis and monitoring of multiple myeloma, light chain disease, Waldenström macroglobulinemia, amyloidosis, and other plasma cell dyscrasias
- Clinical Applications: Screening patients with renal dysfunction, bone pain, or anemia; monitoring treatment response; detecting minimal residual disease; assessing prognosis in hematologic malignancies
- Timing: Performed at initial diagnosis, during treatment, at regular follow-up intervals, and when clinical symptoms suggest disease progression or relapse
Normal Range
- Kappa Free Light Chains: 3.3 - 19.4 mg/L (reference ranges may vary by laboratory)
- Lambda Free Light Chains: 5.7 - 26.3 mg/L (reference ranges may vary by laboratory)
- Kappa/Lambda Ratio: 0.26 - 1.65 (or 0.3 - 1.8 depending on laboratory)
- Units of Measurement: mg/L or mg/dL (milligrams per liter or deciliter)
- Normal Interpretation: Both kappa and lambda values within reference range with a normal ratio indicate polyclonal immunoglobulin production and absence of clonal light chain disease
- Abnormal Interpretation: Elevated kappa or lambda with abnormal ratio suggests monoclonal light chain production consistent with multiple myeloma, light chain disease, or other plasma cell disorders
Interpretation
- Elevated Kappa with Normal or Low Lambda: Suggests monoclonal kappa light chain production; elevated kappa/lambda ratio indicates clonal disorder such as multiple myeloma or light chain disease
- Elevated Lambda with Normal or Low Kappa: Suggests monoclonal lambda light chain production; decreased kappa/lambda ratio indicates clonal disorder
- Both Kappa and Lambda Elevated with Normal Ratio: Suggests polyclonal elevation; may indicate renal impairment, inflammation, autoimmune disease, or secondary elevation of light chains
- Significantly Abnormal Ratio (>3 or <0.1): Highly suggestive of monoclonal light chain disease; indicates likely plasma cell malignancy requiring further diagnostic evaluation
- Factors Affecting Results: Renal function (impairment increases both chains), dehydration, infection, immunosuppression, treatment status, specimen handling, and hemolysis
- Serial Monitoring: Serial changes are more clinically significant than absolute values; decreasing levels during treatment indicate response; increasing levels suggest progression
- Light Chain Cast Nephropathy: Very elevated light chains (>500 mg/L) with abnormal ratio indicate significant kidney disease risk and require urgent intervention
Associated Organs
- Primary Organ System - Hematopoietic System: Bone marrow (site of plasma cell production) and lymphoid tissue
- Secondary Affected Organs: Kidneys (light chain cast nephropathy, acute kidney injury), skeleton (lytic lesions, bone pain), nervous system (amyloidosis), heart (cardiac amyloidosis)
- Diseases Detected/Monitored: Multiple myeloma, light chain myeloma, Waldenström macroglobulinemia, AL amyloidosis, light chain disease, monoclonal gammopathy of undetermined significance (MGUS), primary systemic amyloidosis
- Potential Complications from Abnormal Results: Progressive renal failure, hypercalcemia, anemia, bone disease with pathologic fractures, amyloid tissue deposition with multi-organ involvement, cardiac dysfunction, and neurologic complications
- Kidney Disease Risk: Free light chains filtered by glomerulus cause tubular obstruction; elevated serum-urine light chain levels correlate with kidney injury risk and require protective measures
Follow-up Tests
- If Abnormal Results Found:
  - Serum protein electrophoresis (SPEP) and immunofixation
  - Urine protein electrophoresis (UPEP) and 24-hour urine light chains
  - Bone marrow biopsy and aspirate with morphology, cytochemistry, and flow cytometry
  - Complete blood count (CBC) to assess for anemia
  - Comprehensive metabolic panel (CMP) including calcium and creatinine
  - Skeletal survey or MRI to evaluate for bone lesions
- Complementary Testing:
  - LDH (lactate dehydrogenase) for prognostic assessment
  - Beta-2 microglobulin for staging and prognosis
  - Immunoglobulin quantitation (IgG, IgA, IgM)
  - Cytogenetic and FISH analysis for risk stratification
- Monitoring Frequency:
  - Newly diagnosed myeloma: Every 4-12 weeks during active treatment
  - Treatment response assessment: After each treatment cycle
  - Stable disease: Every 3-4 months during maintenance therapy
  - Remission: Every 6-12 months for disease surveillance
Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for the Kappa and Lambda Freelite chain assay
- Blood Specimen Collection: Serum sample collected via venipuncture; can be obtained at any time of day regardless of food intake
- Specimen Handling: Allow blood to clot completely in SST tube; separate serum within 2 hours; refrigerate if testing delayed; avoid hemolysis which can interfere with results
- Optional Urine Collection: 24-hour urine collection may be ordered simultaneously; patient instructed to collect all urine over 24-hour period starting after morning void
- Medications: No medications need to be held; continue current medications including chemotherapy, corticosteroids, and other treatments; inform laboratory of recent infusions or treatments
- Other Preparation: Adequate hydration recommended; avoid strenuous exercise immediately before collection; inform phlebotomist of any recent transfusions, IV immunoglobulin therapy, or contrast injection studies which may affect interpretation
- Timing Considerations: For patients on treatment, collection should be consistent (e.g., always pre-treatment) for accurate trend analysis; document collection time and date for proper interpretation

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