![]() The quantification of serum IgE was as high as 2.06 × 10 7 IU/mL, whereas 7 other testing institutions reported IgE levels ranging from 1.0 to 1100 IU/mL. The other five institutions did not provide the correct typing results. After pretreatment with 1% β-mercaptoethanol to depolymerize the aggregation of monoclonal protein, the "M-like protein aggregation bands disappeared. Immunofixation electrophoresis (IF) showed "M-like protein aggregation bands" in all lanes. Upon admission to our hospital, the patient's serum free kappa light chain was 1069.9 mg/L, free lambda light chain was 9.2 mg/L, and free kappa/lambda ratio was 115.9, which met the SLiM criteria, but without CRAB features. The results were collected and the causes of IgE detection defects were analyzed. The serum monoclonal protein (M-protein) classification and IgE quantification was performed and sent to several individual institutions. We report a rare case of IgE-MM and investigate the application of the SLiM-CRAB criteria to screen for high-risk smoldering MM (SMM) patients, so as to summarize the causes and methods used to prevent missed diagnosis or misdiagnosis in IgE-MM. Electronic address: multiple myeloma (MM) is a rare subtype of MM that is easily misdiagnosed. Electronic address: 6 Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China. Electronic address: 5 Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China.
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