TEMPLATES FOR IMMUNOLOGY SIGN-OUT (SEMYON A

The gel demonstrates appropriate resolution of the main protein bands. The gamma region shows continuous distribution of proteins both in the CSF and in the serum. No oligoclonal bands are detected.

Interpretation

CSF protein electrophoresis did not reveal evidence of an oligoclonal process in the CNS. The CSF IgG index is within the reference range indicating that there is no elevation in intracerebral IgG synthesis. There is also no evidence of increased permeability of the blood brain barrier based on the CSF/serum albumin ratio.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Normal CSF Electrophoresis with intense staining:

Pattern

The gel demonstrates appropriate resolution of the main protein bands. The gamma region shows continuous distribution of proteins both in the CSF and in the serum. No oligoclonal bands are detected.

The intensity of staining of the main protein fractions in the CSF lane is much stronger than usually seen and is comparable with the intensity of staining in the serum lane.

Interpretation

CSF protein electrophoresis did not reveal evidence of an oligoclonal process in the CNS. The CSF IgG index is within the reference range indicating that there is no elevation in intracerebral IgG synthesis. The CSF/serum albumin ratio is elevated that is most likely due to blood admixture to CSF specimen (the CSF RBC count is 410/ mm3).

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Increased IgG index

The CSF IgG index is elevated indicating that there is an increase in intracerebral IgG synthesis that commonly occurs in acute and chronic inflammatory processes involving CNS, including viral encephalitis, bacterial meningitis, neurosyhilis, subacute sclerosing panencephalitis, acute poliomyelitis, Guillain-Barre syndrome, neurosarcoidosis, and systemic lupus erythematosus.

The CSF/serum albumin ratio is markedly elevated. In the absence of a significant amount of RBCs in the CSF specimen (14600/mm3), this is consistent with increased permeability of the blood brain barrier.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166 -GC

Normal CSF Electrophoresis with suboptimal resolution of protein bands:

Pattern

The gels demonstrate suboptimal resolution of the main protein bands. The gamma-region shows continuous distribution of proteins both in the CSF and in the serum. No bands are identified in this region. CSF immunofixation electrophoresis confirmed the absence of oligoclonal bands.

Interpretation

CSF protein electrophoresis and immunofixation did not reveal evidence of an oligoclonal process in the CNS (see pattern description for limitations). The CSF IgG index is within the reference range indicating that there is no elevation in intracerebral IgG synthesis. There is also no evidence of increased permeability of the blood brain barrier based on the CSF/serum albumin ratio.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC, 86335-GC

Elevated albumin ratio, normal index and no bands (no RBCs in the CSF)

Pattern:

The gels demonstrate appropriate resolution of the main protein bands. The gamma-region shows continuous distribution of proteins both in the CSF and in the serum. No bands are identified in this region. Immunofixation electrophoresis confirmed the absence of oligoclonal bands

The intensity of protein staining in CSF is close to the intensity of staining in the serum.

Interpretation:

CSF protein electrophoresis and immunofixation did not reveal evidence of an oligoclonal process in the CNS. The CSF IgG index is within the reference range indicating that there is no increase in intracerebral IgG synthesis. The CSF/serum albumin ratio is slightly elevated. In the absence of RBCs in the CSF specimen (1/mm3), this is consistent with mildy increased permeability of the blood brain barrier.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166 -GC, 86335-GC

Elevated albumin ratio, normal index and no bands (in the presence of RBCs in CSF)

Pattern:

The gel demonstrates appropriate resolution of the main protein bands. The gamma region shows continuous distribution of proteins both in the CSF and in the serum. No oligoclonal bands are detected.

Interpretation:

CSF protein electrophoresis did not reveal evidence of an oligoclonal process in the CNS. The CSF IgG index is within the reference range indicating that there is no elevation in intracerebral IgG synthesis. The CSF/serum albumin ratio is elevated that in the presence of a significant amount of RBCs (610/mm3) is indicative of blood admixture to the CSF specimen.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Monoclonal band in the serum with corresponding single band in CSF with increased albumin ratio

Pattern:

The gel demonstrates appropriate resolution of the main protein bands. A distinct solitary band is present in the CSF lane with a corresponding band in the serum lane.

Interpretation:

CSF protein electrophoresis results (see pattern description) are consistent with a systemic monoclonal gammopathy and spillage of the monoclonal immunoglobulin into the CSF. The CSF IgG index is within the reference range indicating that there is no elevation in intracerebral IgG synthesis. The CSF/serum albumin ratio is elevated suggesting increased permeability of the blood brain barrier.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Presence of oligoclonal bands

Pattern:

The gel demonstrates appropriate resolution of the main protein bands. Two faint bands are present in the gamma region in the CSF lane that are not seen in the serum lane. The CSF immunofixation electrophoresis confirmed the presence of oligoclonal bands.

Interpretation:

The CSF protein electrophoresis and immunofixation revealed presence of three faint oligoclonal bands in the CSF lane. The CSF IgG index is elevated indicating that there is an increase in intracerebral IgG synthesis. There is no indication of increased permeability of the blood brain barrier based on the CSF/serum albumin ratio. These findings in a proper clinical setting are consistent with the presence on an oligoclonal process involving the CNS.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC, 86335-GC

Presence of oligoclonal bands and lack of a serum sample:

Pattern:

The gel demonstrates appropriate resolution of the main protein bands. Three faint bands are present in the gamma region in the CSF lane. Serum was not submitted for comparison. The CSF immunofixation studies confirm the presence of oligoclonal bands.

Interpretation:

The CSF protein electrophoresis and immunofixation revealed presence of three faint oligoclonal bands in the CSF lane. However, the exact origin of the identified bands cannot be determined since the serum specimen was not submitted for comparison. For the same reason the CSF IgG index and the CSF/serum albumin ratio cannot be calculated.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC, 86335-GC

Serum Protein Electrophoresis

Capillary electrophoresis demonstrates a mild distortion of the gamma zone. This requires further evaluation by serum and 24 hr urine immunofixation

Total protein level is within the reference range. Serum protein electrophoresis shows normal distribution of the main protein fractions.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

The electronic medical record has been reviewed for relevant history.

Capillary electrophoresis does not demonstrate any feature consistent with the presence of a monoclonal gammopathy. Total protein level is within the reference range. Serum protein electrophoresis shows normal distribution of the main protein fractions. Serum protein electrophoresis shows no pathologic changes.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Capillary electrophoresis demonstrates a slight distortion of the gamma zone. This requires further evaluation by serum and 24 hour urine immunofixation.

Capillary electrophoresis demonstrates a mild distortion of the gamma zone. This requires further evaluation by serum and 24 hr urine immunofixation.

Capillary electrophoresis demonstrates an increase with distortion of the gamma zone. This requires further evaluation by serum and 24 hr urine immunofixation.

Total protein level is within the reference range. Serum protein electrophoresis shows reduced albumin level with increase in the beta-2 and gamma fractions, with beta-gamma bridging. These findings are otherwise consistent with chronic liver disease, protein loss, and possible acute inflammation.

Relevant medical information in the EMR was reviewed.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Normal SPE TOP

Total protein level is within the reference range. Serum protein electrophoresis shows normal distribution of the main protein fractions. No monoclonal bands are detected. Serum protein electrophoresis shows no pathologic changes.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Minimal decrease in total protein and albumin:

Total protein is mildly decreased. Serum protein electrophoresis shows minimally reduced albumin level. All globulin fractions are within the reference ranges. No monoclonal bands are detected. Essentially normal serum protein electrophoresis.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Acute inflammation

Total protein is within the reference range. Serum protein electrophoresis shows minimal reduction in the albumin level and an increase in the alpha-1 globulin fraction. All other globulin fractions are within the reference ranges. No monoclonal bands are detected. Serum protein electrophoresis findings are consistent with an acute inflammation.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

SPE

Prominent beta-lipoprotein band

Serum protein electrophoresis shows a prominent beta-lipoprotein band. No other abnormalities are detected. No monoclonal bands are present. This is consistent with hyperlipidemia.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Mild protein loss:

Total protein is mildly decreased. Serum protein electrophoresis shows mildly reduced albumin level with relative elevation of the alpha-1 and alpha-2 globulin fractions. No monoclonal bands are detected. This electrophoretic pattern is consistent with mild protein loss.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Suggested mild protein loss

Total protein is mildly decreased. Serum protein electrophoresis shows mildly reduced albumin level. Other protein fractions are within the normal ranges. No monoclonal bands are detected. This electrophoretic pattern is suggestive of a mild protein loss.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Mild protein loss 2

Total protein is decreased. Serum protein electrophoresis shows mildly reduced albumin and beta globulin fractions. There is no other abnormalities in protein fractions distribution. No monoclonal bands are detected. The electrophoretic pattern is suggestive of a mild protein loss.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

SPE

Protein loss (significant)

Total protein is low. There is also a significant decrease in the albumin level with relative elevation of the alpha-1 and alpha-2 globulin fractions. No monoclonal bands are detected. This electrophoretic pattern is consistent with protein loss.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Protein loss with concurrent inflammation

Total protein is decreased. Serum protein electrophoresis shows markedly reduced albumin level with relative elevation of the alpha-1, alpha-2 and beta globulin fractions. The alpha-1 globulin fraction also shows a mild absolute increase. No monoclonal bands are detected. This electrophoretic pattern is consistent with protein loss and concurrent acute inflammation.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165-GC

Prominent beta lipoprotein band with protein loss

Total protein is low. There is also a significant decrease in the albumin level with relative elevation of the alpha-1 and alpha-2 globulin fractions. No monoclonal bands are detected. A prominent beta-lipoprotein band is present. The electrophoretic pattern is consistent with protein loss and hyperlipidemia.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC SPE

Hypogammaglobulinemia

Total protein and albumin levels are within the reference ranges. A mild decrease in the gamma globulin fraction is present. No other abnormalities are detected. No monoclonal bands are identified. Considering the age of the patient, hypogammaglobulinemia could be an indication of a light chain disease. Recommend urine protein immunofixation electrophoresis to rule out presence of

Bence Jones proteins. Other causes of hypogammaglobulinemia, including lymphoid malignancies, have to be considered. Clinical correlation is required.

Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Hypogammaglobulinemia

Total protein is slightly decreased. There is also a significant decrease in the gamma globulin fraction and a mild reduction in albumin level. There is also a relative elevation of the alpha-2 globulin fraction. This pattern is consistent with mild protein loss and hypogammaglobulinemia. Urine protein immunofixation electrophoresis is suggested to rule out presence of Bence Jones proteins. Other causes of hypogammaglobulinemia, including lymphoid malignancies, have to be considered. Clinical correlation is required.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC SPE

Polyclonal hypergammaglobulinemia with beta-gamma bridging (1)

Total protein is within reference range (or elevated). Serum protein electrophoresis demonstrates mild polyclonal hypergammaglobulinemia with a minimal decrease in the albumin fraction and mild beta-gamma bridging. No monoclonal bands are detected. Polyclonal hypergammaglobulinemia could be associated with chronic inflammation, chronic liver disease, autoimmune and lymphoproliferative disorders. Presence of beta-gamma bridging is usually seen in chronic liver disease/liver cirrhosis. Clinical correlation is required.

I have personally reviewed the test results and concur with the resident's interpretation. `

CPT 84165-GC

Total protein is within reference range. Serum protein electrophoresis demonstrates a significant reduction in the albumin level with a relative elevation in the alpha-1 globulin fraction. The alpha-1 globulin fraction also shows a minimal absolute increase. Polyclonal hypergammaglobulinemia with beta-gamma bridging is present. No monoclonal bands are detected. These findings are consistent with chronic liver disease, protein loss, and possible acute inflammation.

Polyclonal hypergammaglobulinemia could also be associated with chronic inflammation, autoimmune and lymphoproliferative disorders.

I have personally reviewed the test results and concur with the resident's interpretation. `

SPE

CPT 84165-GC

Strong beta-gamma bridging with polyclonal hypergammaglobulinemia (2)

Total protein is within the reference range (or elevated). There is a mild decrease in the albumin level. Prominent polyclonal hypergammaglobulinemia with beta-gamma bridging is present. No monoclonal bands are seen. This pattern is consistent with chronic liver disease/liver cirrhosis.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Polyclonal hypergammaglobulinemia with constriction in gamma region

Total protein is within the reference range. Serum protein electrophoresis shows reduced albumin and beta globulin fractions with mild relative elevation of alpha-1 globulin fraction. Prominent polyclonal hypergammaglobulinemia is present. This could be seen in chronic inflammation, chronic liver disease, in autoimmune and lymphoproliferative disorders.

A faint constriction suspicious for a monoclonal component is seen in the polyclonal background. Recommend serum and urine immunofixation electrophoresis for further evaluation of a possible monoclonal gammopathy.

Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Polyclonal hypergammaglobulinemia with a restricted patten

Total protein is within the reference range (or elevated). Serum protein electrophoresis shows mildly reduced albumin level. A significant polyclonal increase in the gamma globulin fraction with a narrow spectrum of the polyclonal immunoglobulins is seen. No monoclonal bands are identified. This pattern is consistent with hypergammaglobulinemia and restricted heterogeneity in immunoglobulin synthesis. It is usually seen in chronic inflammatory processes associated with EBV, CMV, and HIV infection.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

SPE

Faint monoclonal band on SPEP(1)

Total protein is mildly decreased. Serum protein electrophoresis shows a mildly reduced albumin level with a mild relative elevation of the beta globulin fraction. A very faint monoclonal band is present in the terminal (cathodal) part of gamma region consistent with a low level monoclonal gammopathy. Recommend serum and urine immunofixation electrophoresis for further evaluation. Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Faint monoclonal band on SPEP (2)

Total protein is markedly decreased. There is also a significant decrease in the albumin level and mild decrease in beta globulins. A faint band suspicious for a monoclonal component is present in the proximal (anodal) part of gamma region. Serum Immunofixation electrophoresis studies are recommended for further evaluation. Recommend also urine immunofixation electrophoresis to evaluate for presence of free monoclonal light chains. Please submit a 24 hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Faint monoclonal band on SPEP (3)

Total protein is within the normal range. Serum protein electrophoresis shows normal distribution of the main protein fractions. A faint monoclonal band is present in the terminal (cathodal) part of gamma region consistent with a low level monoclonal gammopathy. Recommend serum and urine immunofixation electrophoresis for further evaluation. Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC SPE

Protein loss with a constriction in gamma region

Total protein is decreased. Serum protein electrophoresis shows mildly reduced albumin and beta globulin fractions with no other abnormalities in the proteins distribution. There is a constriction in the middle of the gamma region suspicious for a monoclonal component. Recommend serum and urine immunofixation electrophoresis for further evaluation of a possible monoclonal gammopathy. Otherwise, the pattern is suggestive of a mild protein loss.

Please submit a 24-hour urine specimen

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Protein loss with constriction in gamma region (2)

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

SPE

Prominent monoclonal band with suppressed background

Total protein is moderately elevated. Serum protein electrophoresis shows a prominent monoclonal band in the gamma region. The polyclonal gamma globulin background is significantly suppressed. Based on the current electrophoretic scan, the concentration of the monoclonal protein is approximately 3.8g/dL. Recommend serum and urine immunofixation electrophoresis for further evaluation.

Please submit a 24 hour urine specimen

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Prominent monoclonal band

Total protein is mildly decreased. Serum protein electrophoresis shows a distinct monoclonal band (0.35 g/dL) in the gamma region consistent with a monoclonal gammopathy. Recommend serum and urine immunofixation electrophoresis for further evaluation. Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84165-GC

Protein loss with a monoclonal band

Total protein is decreased. Serum protein electrophoresis shows a marked decrease in albumin and beta globulin fractions with a relative elevation of alpha-1 and alpha-2 globulin fractions consistent with protein loss. A prominent monoclonal band is present in the proximal part of gamma region. Based on the current electrophoretic scan, the concentration of the monoclonal protein is approximately 0.52 g/dL. Recommend serum and urine immunofixation electrophoresis for further evaluation. Please submit a 24 hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC SPE

Severe protein loss with a monoclonal band

Total protein and albumin levels are severely decreased. There is also a significant decrease in the beta globulins. The alpha-1 and alpha-2 globulin fractions show marked relative elevation. A distinct band is seen in the proximal (anodal) part of gamma region that could represent a monoclonal immunoglobulin. Serum immunofixation electrophoresis studies are recommended for confirmation. Recommend also urine immunofixation electrophoresis on a 24 hour urine specimen to evaluate for presence of free monoclonal light chains. Otherwise the pattern is consistent with severe protein loss.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC

Significant protein loss with a monoclonal band

Total protein is markedly decreased. Serum protein electrophoresis shows a severe decrease in albumin level with a relative elevation of alpha-1 and alpha-2 globulin fractions and mild decrease in beta globulins. A prominent monoclonal band is present in the gamma region. The polyclonal gamma globulin background is significantly suppressed. Based on the current electrophoretic scan, the concentration of the monoclonal protein is approximately 1.1g/dL. The electrophoretic pattern indicated significant protein loss.

Please also see serum immunofixation and urine protein electrophoresis and immunofixation report.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84165 GC SPE

Misinterpreted monoclonal due to plasma processing

The serum immunofixation electrophoresis demonstrates polyclonal distribution of immunoglobulins. No monoclonal immunoglobulins are detected.

Please note that the previous serum protein electrophoresis performed on 07-29-2010 ( acc.# 10-209-006833) identified presence of a prominent band in the anodal part of the gamma region that was interpreted as a monoclonal immunoglobulin. Serum protein electrophorephoresis and immunofixation performed on the current specimen did not detect presence of this band. This discrepancy resulted from submission and processing of an inappropriate specimen on 07-29-2010 (plasma instead of serum) and detection of a fibrinogen band mimicking a monoclonal immunoglobulin.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86334-GC

Serum Immunofixation electrophoresis

Normal polyclonal distribution SIFE TOP

Pattern

Diffusely staining immunoreactivity is present in the IgG, IgA, IgM, kappa, and lambda lanes in a normal polyclonal distribution. No monoclonal immunoglobulins are detected.

Interpretation

The serum immunofixation electrophoresis demonstrates polyclonal distribution of immunoglobulins. No monoclonal immunoglobulins are detected.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86334-GC

Hypogammaglobulinemia

SIFE

Pattern

Very light diffusely staining immunoreactivity is present in the IgG, IgA, IgM, kappa, and lambda lanes in a polyclonal distribution. No monoclonal immunoglobulins are detected.

Interpretation

The serum immunofixation electrophoresis demonstrates polyclonal distribution of immunoglobulins. No monoclonal immunoglobulins are detected. Light staining in all the lanes is suggestive of hypogammaglobulinemia. Recommend quantitative measurement of the serum immunoglobullins to rule out (primary or secondary) immunodeficiency.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86334-GC

Polyclonal hypergammaglobulinemia

Pattern SIFE

Strong diffusely staining immunoreactivity is present in the IgG, IgA, IgM, kappa, and lambda lanes in a polyclonal distribution. No monoclonal immunoglobulins are detected.

Interpretation

The serum immunofixation electrophoresis demonstrates polyclonal distribution of immunoglobulins. No monoclonal immunoglobulins are detected. Strong staining primarily in the IgG , kappa and lambda lanes is consistent with polyclonal hypergammaglobulinemia.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86334-GC

Monoclonal variants

Faint monoclonal band SIFE

Pattern

A faint monoclonal band is present in the IgG lane with a corresponding faint band in the kappa light chain lane. The polyclonal gamma globulin background is preserved in all lanes.

Interpretation

The immunofixation electrophoresis results (see pattern description) are consistent with monoclonal gammopathy of IgG-kappa isotype. Preservation of diffusely staining immunoreactivity indicates that the production of polyclonal immunoglobulins is not suppressed.

Relevant medical information in the EMR was reviewed.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86334-GC

Faint band in IFE

Pattern

A very faint band is identified in the IgG lane with a corresponding faint band in the kappa lane. Diffusely staining immunoreactivity is present in IgG, IgA, IgM, kappa and lambda lanes in a normal distribution.

Interpretation

Serum immunofixation electrophoresis results (see pattern description) are suggestive of a possible low level monoclonal gammopathy of IgG-kappa isotype. The polyclonal gamma globulin background is not affected. Recommend repeat serum immunofixation electrophoresis in 3-6 months for a follow-up and confirmation.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Prominent monoclonal (IgG-lamda isotype with low level of polyclonal immunoglobulins):

Pattern: SIFE

A prominent monoclonal band is present in the IgG lane with a corresponding band in the lambda light chain lane. Faint diffusely staining immunoreactivity is present in IgG, IgA and IgM lanes as well as very faint staining in the kappa and lambda lanes.

Interpretation:

The immunofixation electrophoresis results (see pattern description) are consistent with monoclonal gammopathy of IgG-lambda isotype. Low intensity of protein staining in other lanes indicates suppression of synthesis of polyclonal immunoglobulins.

Relevant medical information in the EMR was reviewed.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 86334-GC

Possible free monoclonal light chains

SIFE TOP

Pattern

A very faint band is identified in the kappa lane with no corresponding bands in any of the other lanes. Diffusely staining immunoreactivity is present in IgG, IgA, IgM, kappa and lambda lanes in a normal distribution.

Interpretation

Serum immunofixation electrophoresis results (see pattern description) are suggestive of the presence of free monoclonal kappa light chains. Recommend urine protein immunofixation electrophoresis for clarification.

Please submit a 24-hour urine specimen.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Urine protein electrophoresis

UPE TOP

24-hour urine electrophoresis

No proteins are detected by protein electrophoresis in the examined urine specimen. There is no evidence of a paraprotein.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Urine electrophoresis (normal) Random

Normal urine protein electrophoresis with a trace amount of albumin. There is no evidence of a paraprotein.

Please note that a random urine specimen was submitted.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Albumin and transferrin band

Urine protein electrophoresis shows presence of a faint albumin band and a faint band in the beta region. The band in the beta region most likely represents transferrin molecules. This is consistent with a mild selective glomerular proteinuria. No paraprotein is detected.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Glomerular and tubular (x3)

Faint bands in urine (all regions)

Faint bands are seen in the albumin, alpha -1 and beta globulin regions consistent with mild glomerular and tubular proteinuria. An additional faint band is seen in the middle of the gamma region indicative of a monoclonal component, most likely free monoclonal light chains. Recommend urine immunofixation electrophoresis on a 24 -hour urine specimen for confirmation.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Faint bands with diffuse staining ( smear pattern)

Urine protein electrophoresis shows presence of a faint albumin, alpha-1, alpha-2 and beta globulin bands. The intensity of albumin band is comparable to the other bands There is also diffuse staining in the alpha-1/alpha-2 and gamma regions. These findings are consistent with glomerular and tubular proteinuria. There is no evidence of a paraprotein.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Faint bands with diffuse staining ( smear pattern) 2

Urine protein electrophoresis shows presence of albumin, alpha-1, alpha-2 and gamma globulin fractions. The intensity of albumin band is comparable to the other bands. This pattern is consistent with mild glomerular and tubular proteinuria.

The band in the alpha-2 region might potentially represent a monoclonal component. Recommend urine protein electrophoresis to rule out this possibility.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Selective gomerular proteinuria

Urine protein electrophoresis shows presence of an albumin band. No other protein fractions are present. This is consistent with (mild, moderate) selective glomerular protienuria. There is no evidence of a paraprotein.

Please note that a random urine specimen was submitted.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Selective gomerular proteinuria with serum monoclonal band

Urine protein electrophoresis shows presence of a faint albumin band consistent with mild selective glomerular protienuria. There is no evidence of a paraprotien. However, considering presence of a monoclonal component in the serum (see a separate report), recommend a urine immunofixation electrophoresis on a 24-hour urine specimen to rule out presence of free monoclonal light chains.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Nonselective glomerular proteinuria

Urine protein electrophoresis revealed presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. There is no evidence of a paraprotein. However, if monoclonal gammopathy is a clinical consideration, recommend urine immunofixation electrophoresis to further evaluate for the presence of free monoclonal light chains.

The estimated total amount of excreted protein is 4.2 g per 24 hour.

Relevant medical information in the EMR was reviewed.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Nonselective glomerular proteinuria (2)

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction. This is consistent with nonselective glomerular proteinuria. No paraprotein is detected.

Please note that a random urine specimen was submitted.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Aberrant band at apha 2/beta globulin region:

Urine protein electrophoresis revealed presence of an albumin, alpha-1 and beta globulin bands. The albumin band is slightly dominant. This pattern is consistent with glomerular and tubular proteinuria. An aberrantly positioned band is seen in the alpha-2 /beta globulin region that is suspicious for a possible monoclonal component. Recommend urine immunofixation electrophoresis on a 24-hour urine specimen to rule out this possibility.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Nonselective proteinuria+monoclonal band

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. A distinct monoclonal band is present in the anodal part of the gamma region. This monoclonal band was not identified on the serum protein electrophoresis and most likely represents free monoclonal light chains.

The amount of excreted total protein and monoclonal light chains cannot be calculated since a random urine specimen was submitted. Recommend urine immunofixation electrophoresis on a 24-hour urine specimen for further definition of the monoclonal component.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Nonselective glomerular proteinuria with constriction in the proximal gamma region:

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. There is a constriction in the proximal part of the gamma region that might represent a monoclonal component. Recommend urine immunofixation electrophoresis on a 24-hour urine specimen for further evaluation.

Estimated total amount of excreted protein is g/24 hour.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Monoclonal band in serum with nonselective glomerular proteinuria

Urine protein electrophoresis of a random urine specimen revealed presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. There is no evidence of a paraprotein. However, urine immunofixation electrophoresis on a 24 hour urine specimen is recommended for further evaluation of a possible presence of free monoclonal light chains.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 84166-GC

Nonselective glomerular proteinuria with a monoclonal band

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. A distinct monoclonal band is present in the anodal part of the gamma region. The amount of excreted total protein and monoclonal component cannot be calculated since there is no information whether the submitted specimen represent a 24-hour or a random urine collection.

Please also see the urine immunofixation electrophoresis report.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Tubular proteinuria

Urine protein electrophoresis shows presence of faint bands and faint diffuse staining in the alpha-1/alpha-2 regions. No other protein fractions are seen. No monoclonal bands are detected. This is consistent with primarily tubular proteinuria.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Prominent band consistent with free hemoglobin (hematuria)

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction consistent with nonselective glomerular proteinuria. A prominent band is seen in the beta region consistent with the presence of free hemoglobin . There is no evidence of a paraprotein.

Recommend urine immunofixation electrophoresis for confirmation.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Weird Cases

Urine protein electrophoresis shows presence of all protein fractions with a dominant albumin fraction. This is consistent with nonselective glomerular proteinuria. A faint band is seen in the gamma zone. Urine immunofixation performed demonstrates IgG-lambda paraprotein with free monoclonal lambda light chains. Blood for serum protein electrophoresis and immunofixation studies was requested; we have not received this as yet.

Children with monoclonal gammopathy, although rare, have been described in the literature. These have been reported in association with immunodeficiency, infections, aplastic anemia, and autoimmune diseases amongst others. The documented paraproteins may actually disappear with time. Such cases are not due to plasma cell neoplasms.

In this case, correlation with serum electrophoresis and immunofixation studies are important. This will demonstrate the presence of the paraprotein in the serum.

Please note that a random urine specimen was submitted.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Urine immunofixation electrophoresis

UIFE TOP

Normal

Pattern

No immunoreactivity is present in any of the lanes.

Interpretation

Immunofixation electrophoresis did not detect any immunoreactivity in the examined urine specimen. No monoclonal immunoglobulins or free kappa or lambda light chains are identified.

The EMR has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Random urine from a patient with low level monoclonal gammopathy in serum.

Pattern

No immunoreactivity is present in any of the lanes. There is no evidence of a paraprotein.

Interpretation

Immunofixation electrophoresis did not detect any immunoreactivity in the examined random urine specimen. No monoclonal immunoglobulins or free kappa or lambda light chains are identified. However, a 24-hour urine specimen has to be examined to rule out presence of monoclonal free light chains. See also serum immunofixation electrophoresis report.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 84166-GC

Spillage of polyclonal immunoglobulins

Pattern

Diffusely staining immunoreactivity is present mainly in IgG, IgA, kappa and lambda lanes. No monoclonal bands are seen.

Interpretation

Urine immunofixation electrophoresis revealed spillage of polyclonal immunoglobulins mainly of IgG and IgA isotypes. There is no spillage of monoclonal immunoglobulins or free monoclonal light chains.

Relevant medical information in the EMR was reviewed.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Spillage of monoclonal band

Pattern

Interpretation.

Urine immunofixation electrophoresis results (see pattern description) are suggestive of the presence of free monoclonal kappa light chains. Please submit 24 hour urine specimen for urine protein immunofixation electrophoresis.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Spillage of monoclonal (IgG-lamda etc. isotype) and polyclonal immunoglobulins

Pattern

A distinct band is identified in the IgG lane with a corresponding band in the lambda lane. Faint diffusely staining immunoreactivity is present in IgG, IgA, kappa and lambda lanes.

Interpretation

Urine immunofixation electrophoresis revealed spillage of monoclonal IgG-lambda immunoglobulin. There is also mild spillage of polyclonal immunoglobulins of IgG and IgA isotypes.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Spillage of free monoclonal light chains (kappa, lambda)

Pattern

A distinct band is identified in the .kappa light chain lane with no corresponding bands in any of the other lanes. Faint diffusely staining immunoreactivity is present in IgG, IgA, kappa and lambda lanes.

Interpretation

Urine immunofixation electrophoresis revealed spillage of free monoclonal kappa light chains along with mild spillage of polyclonal immunoglobulins of IgG and IgA isotypes.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Spillage of free polyclonal light chains (kappa, lambda) - impaired tubular reabsorption

Pattern

Faint diffusely staining immunoreactivity is present in kappa and lambda lanes only. No monoclonal bands are seen.

Interpretation

Urine immunofixation electrophoresis revealed spillage of free polyclonal kappa and lambda light chains consistent with impaired tubular reabsorption. There is no spillage of either monoclonal immunoglobulins or free monoclonal light chains.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 86335-GC

Hemoglobin Electrophoresis

HGB TOP

The electronic medical record has been reviewed for relevant history.

Normal adult pattern

No abnormal hemoglobins are detected; normal hemoglobin electrophoresis pattern.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Iron Deficiency

No abnormal hemoglobins are detected; normal hemoglobin electrophoresis pattern.

The electronic medical record has been reviewed for relevant history. This patient has microcytic hypochromic anemia with iron deficiency. Please note, iron deficiency may falsely lower hemoglobin A2 levels, thus masking beta-thalassemia trait.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

No abnormal hemoglobins are detected; normal hemoglobin electrophoresis pattern.

This patient has microcytic hypochromic anemia. Iron studies are unavailable from the EMR. Differential diagnosis includes iron

deficiency and thalassemia Please note, iron deficiency may falsely lower HbA2 levels, thus masking beta thalassemia trait.

CPT 83020-GC

Normal adult pattern with elevated P2 level

No abnormal hemoglobins are detected. Normal hemoglobin electrophoresis pattern. There is indication of a possible elevation of the glycosylated hemoglobin A level (HbA1C).

The electronic medical record has been reviewed for relevant history.

CPT: 83020 - GC

Beta-thalassemia trait

Classical beta-thalassemia trait

Hemoglobin A2 is significantly elevated ( %). No abnormal hemoglobins are detected. These findings are consistent with heterozygous beta-thalassemia (beta-thalassemia trait). The CBC results (RBC count /mm3, MCV fl, MCH pg RDW %) and the presence of target cells on the peripheral smear support the diagnosis of beta-thalassemia trait.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Increased A2 in neonate

No abnormal hemoglobins are detected. The level of hemoglobin F (8.2%) is appropriate for the age of four months. However, the level of hemoglobin A2 is much higher than expected for this age. This suggests the possibility of beta-thalassemia trait. Recommend follow up and repeat hemoglobin studies in 6-12 months. Hemoglobin studies of the biological parents could be contributory to the final diagnosis.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Normal with iron deficiency anemia, microcytosis. A2 normal or elevated (with suggestion of follow up to look for concurrent beta-thalassemia trait)

No abnormal hemoglobins are detected. Normal hemoglobin electrophoresis pattern. The patient has significant microcytic hypochromic anemia (per EMR) which is most likely due to iron deficiency. However, iron deficiency could lower the level of Hb A2 and interfere with the diagnosis of a concurrent beta-thalassemia trait. Recommend repeat hemoglobin studies, if microcytosis persists 6 weeks after correcting the iron status.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 83020-GC HGB

Mild elevation of A2

Hemoglobin A2 is slightly elevated. No abnormal hemoglobins are detected. This could be a variant of normal. However, heterozygous beta-thalassemia should be considered especially if the patient presents with iron deficiency anemia.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation

CPT: 83020-GC

Normal in child (with suggestion of follow up to look for concurrent beta-thal trait)

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT: 83020-GC

Normal pattern with increased HbF in a I year old

Hemoglobin electrophoresis shows elevated level of hemoglobin F (3.7%). No abnormal hemoglobins are detected. An elevated level of hemoglobin F could be seen at this age as a variant of normal. However, increase in hemoglobin F might be associated with numerous pathologic conditions such as aplastic anemia, anemia of chronic disease, pernicious anemia, some hematologic malignancies etc. Hematological and clinical correlation is recommended.

Also recommend follow-up and repeat hemoglobin studies in 6-12 months.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

HGB

Increased A2 and F in a child

Hemoglobin electrophoresis shows elevated levels of hemoglobin A2 and F. No abnormal hemoglobins are detected. An elevated level of hemoglobin F could be seen at this age as a variant of normal. However, this level of hemoglobin A2 might indicate presence of a beta-thalassemia trait. Recommend repeat hemoglobin studies in 3-6 months.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Increased hemoglobin F in a young child

Hemoglobin electrophoresis shows elevated level of hemoglobin F. No abnormal hemoglobins are detected. An elevated level of hemoglobin F could be seen at this age as a variant of normal. However, increase in hemoglobin F might be associated with numerous pathologic conditions such as aplastic anemia, anemia of chronic disease, pernicious anemia, hematologic malignancies etc. Recommend follow the patient and repeat hemoglobin studies in 6-12 months.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Iron deficiency anemia (with MCV 60 and some target cells)

No abnormal hemoglobins are detected. Normal hemoglobin electrophoresis pattern. The patient has significant iron defiency (per EMR) that could lower the level of Hb A2 and interfere with the diagnosis of beta-thalassemia trait. Recommend repeat hemoglobin studies if microcytosis persists after correcting the iron status.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

HGB

Sickle cell trait

Hemoglobin electrophoresis results are consistent with sickle cell trait (Hb AS), unless the patient has been recently transfused. Slightly elevated levels of Hb A2 can be seen in association with sickle cell trait.

The electronic medical record has been reviewed for relevant history.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hemoglobin S 15%:

Hemoglobin studies revealed presence of 15.4% of hemoglobin S. This level of hemoglobin S could be seen either in a patient with sickle cell disease (HgbSS) on a chronic transfusion protocol or in a sickle cell trait individual massively transfused for any other cause. Alpha-thalassemia trait could be also a contributing factor. Transfusion history is essential for the final diagnosis and is not available from the EMR..

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

HGB

Hb S >60% with presence of HbA (19.7%) and increased HbF and HbA2 (adult)

Hemoglobin electrophoresis shows presence of 66.8% of hemoglobin S and 19.7% of hemoglobin A. There is also an increase in hemoglobin F level (9.6%). This may be consistent with either sickle cell disease (Hb SS), status post RBC transfusion or with S/beta (+) -thalassemia hemoglobinopathy. Transfusion history is essential for the final diagnosis. Hematological and clnical correlation is necessary.

I have personally reviewed the test results and concur with the resident's

interpretation.

CPT 83020-GC

Hb S = 50% in presence of HbA and increased HbF (24.5%), HbA2(5%) (3 yr old)

Hemoglobin electrophoresis revealed 47.8% of hemoglobin S, 22.7% of hemoglobin A and 24.5% of hemoglobin F. The level of hemoglobin A2 is 5%. Considering this information and the CBC results (MCV 77.6 fL, RBC 4.53/mm3, RDW 17.9%) the most likely diagnosis is either S/beta (++)- thalassemia hemoglobinopathy or S/ HPFH (hereditary persistence of fetal hemoglobin). Homozygous sickle cell disease (Hb SS), status post RBC transfusion is also a possibility. Hematological and clnical correlation is necessary. Transfusion history is essential for the final diagnosis.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Sickle cell disease

HbS 81%, Hb F 15, HbA2 3.9, absent HbA (2 yr old)

Hemoglobin electrophoresis results are consistent with sickle cell disease

(Hgb SS). The current level of Hb S is 81.1%, the level of Hb F is 15.0%, and the level of Hb A2 is 3.9%.

I have personally reviewed the test results and concur with the resident's

interpretation.

CPT 83020-GC

HGB

Sickle cell disease (Hb SS) s/p RBC transfusion/exchange (Hb A 53%)

Hb S >60% in absence of HbA and increased HbF, normal HbA2 (3 yr old)

Hemoglobin electrophoresis shows presence of 79% of hemoglobin S and 17.7% of hemoglobin F. This may be consistent with the following conditions: homozygous S disease (Hb SS), S/beta (0) - thalassemia hemoglobinopathy, S/ HPFH (hereditary persistence of fetal hemoglobin). Hematological and clnical correlation is necessary.

I have personally reviewed the test results and concur with the resident's

interpretation.

CPT 83020-GC HGB

Hb S >60% with HbA (15-30%), elevated Hb A2 and HbF

Hemoglobin electrophoresis revealed 68.2% of hemoglobin S and 21.7% of hemoglobin A. No history of recent blood transfusion is available from EMR. Considering this information, the level of hemoglobin A2 (6.5%) and the CBC results (MCV 67 fL, RBC 4.92/mm3, RDW 16.2%) S/beta (++) thalassemia hemoglobinopathy is the most likely condition. Transfusion history is essential for the final diagnosis.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hb S >60% in absence of HbA and increased HbF, normal HbA2 (1 yr old)

Hemoglobin electrophoresis results are consistent with a sickle cell

disease (Hb SS) The current level of hemoglobin S is 77.6%. The high level of hemoglobin F (18.8%) is most likely due to the patient's age and the current hydroxyurea treatment (per EMR).

I have personally reviewed the test results and concur with the resident's

interpretation.

CPT 83020-GC

S/beta(0)-thalassemia

Hb S 75 % no HbA, elevated Hb A2 and HbF

Hemoglobin electrophoresis revealed 75% of hemoglobin S. No hemoglobin A is present. The level of hemoglobin A2 is 6.5% and hemoglobin F- 18.5%. Thise results are consistent with S/beta (0)- thalassemia hemoglobinopathy. The CBC results (RBC 4.92/mm3, MCV 67 fL , MCH 23 pg and RDW 16.2%) support the diagnosis of S/beta (0)-thalassemia hemoglobinopathy.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

HGB

Hb C trait with Hb C levels >25%

Hemoglobin electrophoresis results are consistent with hemoglobin C trait (HgbAC). The current level of hemoglobin C is 39.7%. Heterozygous C hemoglobinopathy is a benign condition. However, knowledge of the presence of this condition is important for future reproductive counseling.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hb C trait with Hb C levels <25%

Hemoglobin electrophoresis results are consistent with hemoglobin C trait (Hgb AC). The current level of hemoglobin C is 21%. It is less than usually seen in hemoglobin C trait individuals that could be due either to transfusion or to a possible concurrent alpha-thalassemia trait. Hematological and clinical correlation is necessary.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

HGB

Hemoglobin SC disease:

Hemoglobin electrophoresis results are consistent with Hb S/C disease. Current level of hemoglobin C is 41.6%.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hb SC disease s/p transfusion/exchange (Presence of HbA )

Hemoglobin electrophoresis revealed presence of 20% of hemoglobin S, 11.8% of hemoglobin C, and 63.1% of hemoglobin A. According to the EMR, the patient had multiple episodes of sickle cell crises and received multiple transfusions. Considering this information, the findings are consistent with S/C disease status post transfusion.

I have personally reviewed the test results and concur with the resident's

Interpretation.

CPT 83020-GC

Hemoglobin E trait in an adult

Hemoglobin electrophoresis results are consistent with hemoglobin E trait. The current level of Hgb E is 5.6% which is low comparatively to the usual level of about 30%. Hemoglobin E is most frequently encountered in individuals of Southeast Asian origin but it is not absolutely limited to this population. Hemoglobin E trait is known to be a benign condition, however it is often associated with iron deficiency.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hemoglobin E trait in a child

Hemoglobin electrophoresis results are consistent with hemoglobin E trait in a child of this age. The current level of hemoglobin E is 20.2 %. Hemoglobin E trait is a benign condition, it is not associated with significant anemia. Microcytosis, slight hypochromia and occasional target cells should be expected.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC

Hemoglobin E (homozygous)

Hemoglobin electrophoresis results are consistent with homozygous hemoglobin E hemoglobinopathy. Elevation of hemoglobin F is usually seen in this condition, which is almost entirely restricted to individuals of Southeast Asian origin. It is known to be a benign condition, which might present as a thalassemia minor. Reproductive counseling is important since double heterozygotes (E/beta-thalassemia) could develop severe thalassemic disorder.

I have personally reviewed the test results and concur with the resident's interpretation.

CPT 83020-GC