Unexplained fatigue, weight loss, or recurrent infections? Serum Protein Electrophoresis (SPEP) could be the key to uncovering serious conditions like multiple myeloma, chronic infections, or autoimmune diseases.

But when should we order it, and how do we interpret tricky results of SPEP?

This article simplifies SPEP, breaks down immunofixation and immunofluorescence, and provides a practical roadmap for us to make informed, evidence-based decisions in primary care.

We work through the evaluation of mild ALT elevation in asymptomatic adults in primary care by tackling these commonly asked questions:

1. What differential diagnoses should we consider with mildly elevated ALT?

2. How do we diagnose metabolic dysfunction-associated fatty liver disease?

3. How do we estimate risk of liver fibrosis using the FIB-4 score? What lab tests and diagnostic imaging should we consider?

We answer these common questions and more!

Read time: 6-7 minutes

We review diagnostic pearls for thalassemia, including use of the CBC, iron studies, peripheral blood smear, and hemoglobin electrophoresis

Read time: 6-7 minutes

We review the utility of ESR and CRP as inflammatory markers when evaluating patients for suspected inflammatory or infectious disease processes.

Read time: 6-7 minutes

We review the utility of serum TSH, free T4, free T3, and when to order thyroid antibody testing (hint - almost never!)

We review how lab reference ranges are established, the limitations of lab reference ranges, and tips for dealing with lab results that do not correlate clinically.