[Music] what does monoclonal protein or an M protein or an M spike and how is it detected that's actually a question I get asked in the clinic almost all the time I mean this is a protein that we can detect in the blood but it really derives from something called an antibody myeloma at its core is a cancer of plasma cells and plasma cells are the body's natural Factory for antibodies so if someone early in their childhood for example receives a vaccine to chickenpox or measles or let's say they actually had chickenpox or measles they will then go on to develop an immune response that one aspect of which is the development of a clonal memory or population of plasma cells what that means is you have a group a small population of plasma cells in your body that make a specific antibody that targets let's say the chickenpox or the measles and helps protect you from subsequent infections because you have some amount of that antibody in your blood in a healthy person the body usually makes many clones of many different plasma cells which each make their own antibodies these antibodies fight off many different diseases this is polyclonal because there are many clones of many distinct plasma cells myeloma is a cancer of plasma cells and since it is derived from plasma cells it also makes an antibody and that the myeloma is also a clonal proliferation meaning its proliferation or multiplication of the same cell or a cell derived from the same plasma cell and it therefore makes the same kind of antibody over and over and over again and that we detect as a clonal spike in the blood when we run something called an S Pen on the blood so in the blood we can detect this protein by some chemical properties basically not to go into too much sort of of wet chemistry but we essentially run all of the blood proteins across an electrical gradient and they separate based on how how they travel through through a magnetic or I'm sorry electrical gradient and you can detect a normal pattern of something called polyclonal pattern on this thing called an electrophoresis of protein electrophoresis or you can detect a spike and that's where you have too much or of a specific clonal protein derived from these clonal plasma cells on a bone marrow biopsy what you're really looking for is how the cells actually look and there you can't really detect the monoclonal protein or the EM spike what you do detect is the type of antibody so these antibodies can come in several flavors and the flavors each have like a chocolate and a vanilla so what I mean by that is you can have an IgA antibody an IgG antibody IgE IgG IgM and each one of those can have as I said chocolate and vanila but in our case we call them Kappa and lambda and if you have a polyclonal meaning you don't have a clonal response there's an expected ratio of Kappa and lambda that can be detected or essentially stained for in the bone marrow and and visualized if you have a clonal proliferation of or multiplication of plasma cells then they tend to be all Kappa or all lambda or that sort of normal ratio is significantly skewed toward one or the other and that tells you that you have a clonal process one can look at this in a variety of different ways in a bone marrow you can do that on a biopsy and you can also do that on the aspirin as well using something called the flow cytometry you can track your M protein as well as all your other myeloma labs at health tree org under the myeloma labs tab on the left side