ADLM Meeting of the Minds

Lab supervisors; Lab directors (and/or assistant directors); Lab managers (supervisory and/or non-supervisory); Medical technologists; Physicians; Pathologists; In-training individuals

Basic

After participating in this course, participants will be able to: 

• Explain the fundamentals of protein electrophoresis, including different methodologies, gating practices, and supplemental testing.
  
• Identify best practices for testing workflows, reporting, and working up challenging cases and now to implement them in our own practice.
  
• Identify what diseases are assessed by protein electrophoresis and which additional tests to perform for different diseases.

• Moderator: Katherine Turner, PhD, DABCC, FADLM, Michigan Pathology Specialists
  
• Robert Maynard, PhD, DABCC, NRCC, University of Kentucky
  
• David Manthei, MD, PhD, University of Michigan

(15 minutes) Welcome and introduction

The course will open with an overview of the agenda, materials, and faculty. The course will heavily rely on small-group, case-based learning where participants work through real-world laboratory cases. This includes hands-on review of physical gels and discussion key lessons and best practices. The course will include polling, small group discussion, and facilitated hands-on exercises.

• Overview of agenda, materials, and faculty introductions
• Small-group breakout sessions with interactive, case-based learning
• Review of real-world laboratory cases, including physical gels on lightboxes
• Group discussion of key lessons and best practices
• Polling to reinforce learning throughout

(30 minutes) Level 1 protein electrophoresis methods and interpretation practices 

The faculty will provide a blended and interactive presentation reviewing available protein electrophoresis methodologies, including gel-based and capillary electrophoresis, along with commonly used supplemental tests such as immunotyping, serum free light chains, and quantitative immunoglobulins. Audience polling will be used to assess participants’ baseline familiarity with current techniques and practices, as well as to highlight current International Myeloma Working Group and College of American Pathologists recommendations for monoclonal gammopathy testing. A series of introductory cases will be presented to reinforce foundational concepts, including routine PEP and immunotyping interpretation, the value of complementary use of standard and supplemental testing, and recognition of common interpretation pitfalls.

• Protein electrophoresis methods and supplemental tests
• Audience polling and current guidelines (IMWG/CAP)
• Introductory case studies
• Complementary testing and common pitfalls

(15 minutes) Break

(45 minutes) Level 2 interpretation and reporting practicum 

This section will build on foundational concepts through a series of advanced, case-based exercises. The faculty will guide participants through in-depth evaluation of immunotyping, including both gel-based immunofixation and capillary-based immunosubtraction. Basic interpretation principles will be reviewed alongside advanced tips and techniques. Working in small groups, participants will analyze cases using physical gels viewed on lightboxes and immunosubtraction spectra, followed by facilitated group discussion to reinforce best practices in immunotyping interpretation and reporting.

• Hands-on gel examination exercises
• Routine PEP and immunotyping interpretation
• Complementary use of standard and supplemental testing
• Gel-based and capillary immunotyping cases
• Small-group case review with physical gels and spectra
• Discussion of best practices and common pitfalls

(15 minutes) Break

(45 min) Case workups, oddities, and reporting consistencies

The faculty will lead a case-based session that expands on prior sections by addressing testing recommendations tailored to patient characteristics, variations in testing methods and reporting approaches, and atypical or challenging cases. These include examples of analytical interferences and mimics. Participants will independently examine gels before engaging in group discussions and a facilitated Q&A session. Case topics will include general interpretation principles; indications for additional upfront or reflex testing based on clinical context or initial results; differing approaches to M‑protein quantitation, such as tangent skim, perpendicular drop, or immunoglobulin-based methods; assessment of treatment response and therapeutic monoclonal antibody interference; and confounding conditions including IgG4-related disease, imaging contrast agents, hemolysis, and incomplete serum clotting.

• Hands-on gel examination exercises
• Patient-tailored testing and method variations
• Analytical interferences and mimics
• M‑protein quantitation approaches and treatment response assessment
• Confounding conditions (IgG4 disease, contrast agents, hemolysis, incomplete clotting)
• Individual gel review followed by group discussion and Q&A

(15 minutes) Closing and Q&A (All)

The course will conclude with a comprehensive question and answer session, allowing faculty to address remaining questions, clarify complex cases, and reinforce key take‑home messages for practical application in clinical practice.