Immunoelectrophoresis Results: Concerns About Liver Cirrhosis

Hello, doctor. I would like to inquire about the immunoelectrophoresis findings that suggest liver cirrhosis?

A few days ago, I underwent an immunofixation electrophoresis test at my own expense due to personal reasons, and the results are as follows: total protein 7 g/dL, albumin 62.3% (reference range 54-60, elevated), alpha-1 2.2% (reference range 1.8-4.0), alpha-2 6.1% (reference range 7.6-10.9, decreased), beta 12.8% (reference range 11.4-16.1), gamma 16.6% (reference range 13.4-20.7).
Additionally, a suspected β-γ bridging was observed as shown in the image link: https://ibb.co/bbq3JL1.
Over the past year, my liver function tests have consistently remained in the teens.
In my most recent check-up on June 4, all liver function parameters were normal: ALK 63 and GGT 18.
I also underwent a self-paid ultrasound at the clinic, which only indicated mild fatty liver.

I would like to ask:
1.
Does the abnormal electrophoresis raise concerns for liver cirrhosis?
2.
Can β-γ bridging occur in healthy individuals? If there are issues, which specialty should I consult?
3.
With the decrease in alpha-2 protein and no anemia present, what other concerns could there be besides liver cirrhosis?

nan sheng, 30~39 year old female. Ask Date: 2024/06/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to consult an immunologist.

Reply Date: 2024/06/30

More Info

Interpreting immunoelectrophoresis results can be complex, especially when considering potential liver conditions such as cirrhosis. Based on the results you provided, let's break down the findings and address your concerns.

1. Immunoelectrophoresis Results: Your total protein level is 7 g/dL, which is within the normal range. The albumin level is slightly elevated at 62.3%, which is generally considered a good sign, as albumin is a protein produced by the liver and is crucial for maintaining oncotic pressure and transporting substances in the blood. The alpha-1 and alpha-2 globulin levels are within normal limits, but the beta globulin is at 12.8%, which is also within the reference range. The gamma globulin level is 16.6%, again within the normal range.

The presence of a "beta-gamma bridge" in your results can be indicative of certain conditions, including chronic liver disease, but it is not definitive for cirrhosis. The beta-gamma bridge occurs when there is an increase in both beta and gamma globulins, often seen in chronic inflammatory states or liver dysfunction. However, it can also be present in healthy individuals, particularly if they have a mild infection or inflammation.

2. Concerns About Liver Cirrhosis: Your liver function tests (alkaline phosphatase and gamma-glutamyl transferase) are normal, and you have mentioned that your liver indices have been stable over the past year. This is a positive sign. While immunoelectrophoresis can show abnormalities that might suggest liver disease, the absence of significant liver enzyme elevation and the presence of only mild fatty liver on ultrasound are reassuring. Cirrhosis typically presents with more pronounced liver dysfunction and structural changes, which do not seem to be indicated in your case.

3. Beta-Gamma Bridge in Normal Individuals: The beta-gamma bridge can indeed appear in healthy individuals, particularly in response to various stimuli such as infections or autoimmune conditions. It is not exclusively indicative of liver cirrhosis or severe liver disease. Therefore, while it warrants further investigation, it does not automatically imply a serious condition.

4. Alpha-2 Protein Decrease: A decrease in alpha-2 globulin can be associated with several conditions, including protein-losing enteropathy, nephrotic syndrome, or chronic liver disease. However, since you do not have anemia and your liver function tests are normal, it may not be a cause for alarm. It is essential to consider the clinical context and any symptoms you may be experiencing.

5. Next Steps: Given your results and concerns, it would be prudent to consult with a hepatologist or a gastroenterologist specializing in liver diseases. They can provide a more comprehensive evaluation, possibly including additional imaging studies or liver biopsy if necessary, to rule out any significant liver pathology. Regular monitoring of liver function tests and imaging studies can help track any changes over time.

In summary, while your immunoelectrophoresis results show some abnormalities, they do not definitively indicate liver cirrhosis, especially in the context of normal liver function tests and mild fatty liver. It is essential to continue monitoring your liver health and consult with a specialist for personalized advice and management.

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