INTRODUCTION:
Serum protein electrophoresis (SPE) is performed on healthcare workers as part of a health surveillance protocol regulated by law. Exams are performed, according guidelines in use, every two years to workers exposed to biohazard and annually to low dose (<100mSv) ionizing radiation (IR).

METHODS:
The study population consists of 954 employees at hospital of cittadella (589 females; 365 males), according availability, between 2020 and 2025, of a normal SPE at t0; at least one SPE performed at t1. 787 people (478 females; 309 males) were classified as exposed to relevant occupational risks: 649 to high health care-related biohazard only; 138 to IR too. The remaining 167 people were classified exposed to only generic biohazard (unexposed). In our study, we focus on protein alterations in β and/or γ region: suspicious β-region spike; β1-β2 bridge; unexplained increase in the β-region; and monoclonal spike in γ-region (and its evaluation with reflex test).

RESULTS:
We found monoclonal spike in 8 cases: 7 low-risk MGUS (not IgM); 1 intermediate risk MGUS (M-protein). Progression to MGUS from alterations in the β-region was observed in 7 cases. We observed no statistically significant differences in MGUS prevalence compared to the general population. We therefore identified 89 cases with altered β-region and no progression to MGUS. Prevalence of β-region alterations is significantly higher in those exposed to occupational risk (p: 0.0129), with no apparent differences between those exposed to biohazard only and those also exposed to IR. Persistence of the test’s alteration after the initial finding was observed in 37 cases. For these, a thorough risk-related (occupational and non-occupational) anamnesis was performed and the test was repeated after 1 year.

CONCLUSIONS:
Recognizing small alterations of β-region bands in SPE (a sustainable and inexpensive test) may provide the clue to detecting a non-malignant condition that may progress to neoplasm.