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Information ⬇

Synonym/Acronym

IFE.

Rationale

To identify the individual types of immunoglobulins, toward diagnosing diseases such as multiple myeloma, and to evaluate effectiveness of chemotherapy.

Patient Preparation

There are no food, fluid, medication, or activity restrictions unless by medical direction. As appropriate, provide the required urine collection container and specimen collection instructions.

Normal Findings

(Method: Immunoprecipitation combined with electrophoresis) Test results are interpreted by a pathologist. Normal placement and intensity of staining provide information about the immunoglobulin bands.

Critical Findings and Potential Interventions ⬆ ⬇

N/A

Overview ⬆ ⬇

(Study type: Blood collected in a gold-, red-, or red/gray-top tube; related body system: Circulatory/hematopoietic and immune systems. Place separated serum in a standard transport tube within 2 hr of collection. Place urine from a random or timed collection in a clean plastic container.)

Immunofixation electrophoresis (IFE) is a qualitative technique that provides a detailed separation of individual immunoglobulins according to their electrical charges followed by the application of specific antiserum (anti-IgM, anti-kappa, etc.) and a stain, to help visualize the patterns. It is usually requested when there is an abnormality in the gamma globulin fraction of a serum protein electrophoresis, either monoclonal or polyclonal. IFE is frequently used to identify the three main immunoglobulin groups (IgG, IgM, and IgA) and the light-chain proteins (kappa and lambda). Antisera for IgE and IgD are available for use, if indicated. Abnormalities are revealed by changes produced in the individual bands, such as displacement compared to a normal pattern; intense color, which reflects an increase; or absence of color, which reflects a decrease. Urine IFE has replaced the Bence Jones screening test for light chains. IFE has replaced immunoelectrophoresis because it is more sensitive and easier to interpret. IFE is used to help detect, diagnose, and monitor the course and treatment of conditions such as chronic kidney disease, multiple myeloma, and Waldenström macroglobulinemia.

Indications ⬆ ⬇

Interfering Factors ⬆ ⬇

Other Considerations

  • Chemotherapy and radiation treatments may alter the width of the bands and make interpretation difficult.
  • All urine voided for the timed collection period must be included in the collection, or else falsely decreased values may be obtained. Compare output records with volume collected to verify that all voids were included in the collection.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

See the “Immunoglobulins A, D, E, G, and M” and “Protein and Urine, Blood, Total and Fractions” studies.

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Discuss how this test can assist in assessing the immune system.
  • Explain that a blood or urine sample is needed for the test. Information regarding urine specimen collection is presented with other general guidelines in Appendix A: Patient Preparation Specimen Collection.

Potential Nursing Actions

  • Investigate as to whether the patient received any vaccinations or immunizations within the last 6 mo or any blood or blood components within the last 6 wk, as these might interfere with accurate interpretation of test results.
  • Include on the timed collection container’s label urine total volume, test start and stop times/dates, and any medications that may interfere with test results.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

  • Discuss reportable symptoms that indicate disease progression: constipation, nausea, poor appetite and weight loss, excessive thirst, bone pain and lower extremity numbness and weakness, fatigue, confusion or feeling mentally foggy, frequent infection.
  • Interventions/actions include the following: Monitor and trend Hgb, Hct, platelets, and RBC count secondary to chemotherapy. Administer prescribed steroids, erythropoietin, and ordered blood products. Discuss exposure to microbes that could result in infection secondary to suppressed immune response.

Safety Considerations

  • Discuss fall injury risk related to pain, weakness, muscle deconditioning, limited movement, ongoing fatigue, failing endurance, and bone weakness with osteoporosis related to disease process. Combat fall injury risk by facilitating the use of assistive devices, range of motion, moving and changing position every 2 hr, ensuring an uncluttered environment.
  • Institute bleeding precautions. Provide a soft toothbrush. Avoid aspirin, intramuscular and IV injections. Coordinate laboratory draws to minimize venipuncture.

Nutritional Considerations

  • The patient makes dietary selections that may include omitting fresh fruit to decrease exposure to bacteria.

Clinical Judgement

  • Consider spiritual guidance needs in association with a diagnosis of cancer or life-altering, debilitating disease.

Follow-Up Evaluation and Desired Outcomes

  • Understands that additional testing may be necessary to evaluate or monitor disease progression and determine the need for a change in therapy.