Monoclonal Gammopathy

  • Plasma cell disorders
    • Monoclonal gammopathy of undetermined significance (MGUS)
    • Biclonal gammopathy of undetermined significance
    • Idiopathic Bence Jones proteinuria
    • POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome
    • Osteosclerotic myeloma
    • Castleman's disease
    • AL (light chain) amyloidosis, light chain and heavy chain deposition diseases
    • Solitary plasmacytoma
    • Multiple myeloma, smoldering multiple myeloma


  • B-cell lymphoproliferative disorders
    • Non-Hodgkin's lymphoma
    • Chronic lymphocytic leukemia
    • Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)
    • Post-transplant monoclonal gammopathies
    • Heavy chain diseases
  • Connective tissue disorders
    • SLE
    • RA
    • Sjogren syndrome
    • Scleroderma
    • Psoriatic arthritis
    • Polymyalgia rheumatica
  • Associated with infections
    • Hepatitis C
    • HIV/AIDS
  • Dermatologic disorders
  • Miscellaneous disorders
    • Acquired von Willebrand disease
    • Acquired angioedema (acquired C1-INH deficiency)
    • Eosinophilic fasciitis
    • Cryoglobulinemia, cryofibrinogenemia
    • Myelodysplastic syndrome
    • Chronic neutrophilic leukemia
    • Sensorimotor neuropathy with MGUS
    • Capillary leak syndrome
    • T-cell large granular lymphocyte leukemia
    • Cold agglutinin disease

Polyclonal Gammopathy

In 148 patients with polyclonal gamma globulin level ≥3 g/dL:
  • Liver disease (61%)
    • Most with autoimmune hepatitis
    • Rest included hepatitis C, hepatitis B, primary biliary cirrhosis, primary sclerosing cholangitis, ethanol-induced liver injury, cryptogenic cirrhosis, primary hemachromatosis, and alpha-1 antitrypsin deficiency
  • Connective tissue disease (22%)
    • Sjögren syndrome most common, followed by RA, SLE, mixed CTD
  • Chronic infection (6%)
    • Hepatitis C and B
    • HIV
      • Polyclonal gammopathy with bone marrow plasmacytosis is a common finding in HIV; these patients also have an increased incidence of clonal plasma cell disorders (eg, MGUS, multiple myeloma, plasmablastic lymphoma)
  • Hematologic disorders (5%) - benign and malignant B and T lymphoproliferative disorders (including benign lymphoproliferative disorders, lymphomas, lymphocytic leukemias, myelodysplastic syndrome)
  • Non-hematologic malignancy (3%) - hepatocellular carcinoma, ovarian carcinoma, squamous cell carcinoma of the lung, pancreatic adenocarcinoma, renal cell carcinoma, and chondrosarcoma

Elevated IgE

Immunoglobulin Reference Values