[Mharper2894]

22 years old, low IgG, IFE shows 1 M lambda

by Mharper2894 on Tue Aug 30, 2016 10:39 pm

Hi! I am a 22 year old female, and would like some insight on my lab results.

Low IgG : 648
Low IgG subclass 2: 182
Low B cells and NK cells (see attached picture)
Also, IFE showed 1 M lambda

They said they are going to do a repeat blood test and 24-hour urine next.

I have not been diagnosed with anything yet. All the tests are being run because of frequent re­current infections, and poor immune function. I've also been experiencing severe neck and back pain and have shrunk by two inches.

Any insight would be greatly appreciated! I have no clue what these results could suggest.

LabResults.png (57 KiB) Viewed 736 times

[Ian]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Ian on Wed Aug 31, 2016 12:04 am

Welcome to the forum, Meagan.

Do you also have results for the following laboratory tests?

1. IgA and IgM
2. Kappa and lambda free light chain levels (from the serum free light chain test)
3. Serum protein electrophoresis (SPEP) test, especially any estimate it provides of the "M-spike", "paraprotein", "abnormal protein 1", "monoclonal protein", etc
4. Serum creatinine level
5. Serum calcium level
6. Haemoglobin level

If you have some or all of those test results, it would help us give you better advice if you could share them with us.

Also, please provide units with test results when sharing them with us.

Cheers!

[Mharper2894]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Mharper2894 on Wed Aug 31, 2016 2:34 am

IgA: 148 mg/dL
IgM: 163 mg/dL

Here are the verbatim results of the IFE (leaving out the names of the doctors). It just said the reference range was 0 M protein:

IFE

Date: Aug 01, 2016 11:13 a.m.
Ordered by: -- MD

Note: Aug 02, 2016 03:28 p.m.
1 M Lambda Reviewed by -- M.D.

Note: Aug 02, 2016 03:28 p.m.
Reference Range:
No monoclonal immunoglobulins detected.

Creatinine: 1.0 mg/dL
Calcium: 9.8 mg/dL
Hgb: 12.3

[Multibilly]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Multibilly on Wed Aug 31, 2016 6:50 am

Hi Meagan,

I'm so sorry to hear what you are going through.

Perhaps others might know, but I don't what "1 M Lambda" on the IFE test means. But the IFE test does go on to say that "no monoclonal immunoglobulins detected", which helps rule out some of the more common forms of multiple myeloma and related diseases. But note that there are forms of multiple myeloma where urine and blood tests won't necessarily reveal the presence of a plasma cell disorder like multiple myeloma. You instead need a bone marrow biopsy to determine its presence.

The fact that you have a compromised immune system and have shrunk two inches at age 22 and have skeletal and/or musculoskeletal pain would also beg for a PET/CT or MRI to determine just what kind of bone damage your are experiencing. I might also think about getting a DEXA (bone density) scan. What kind of radiological imaging (if any) have you had and what were the findings?

A 24 hour urine test may also help to provide some more clues. Repeating the blood tests also sounds like a good idea.

Lastly, what kind of doctor is evaluating you?

Wish I could be of more help, but it sounds like you will need some more tests to get to the bottom of all this.

[JimNY]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by JimNY on Wed Aug 31, 2016 9:03 am

Hi Meagan and Multibilly,

I haven't seen the "1 M Lambda" result before either, although I'm guessing that it means that a lambda-restricted monoclonal protein has been detected. The lambda restriction would fit with the below-normal kappa/lambda ratio, although that result seems to be for a TOTAL, not FREE, light chain blood test.

I'm also guessing that the statement "No monoclonal immunoglobulins detected" is the "Reference Range" result, not the actual result of this test. That is, a healthy person will have "No monoclonal immunoglobulins detected" as the result of this test in most cases.

So I suspect a monoclonal protein was detected. The problem is that we don't know exactly how much monoclonal protein is present, which is why the result of an SPEP test would be helpful.

The IgG, IgA, and IgM results suggest, however, that not much monoclonal protein is present, since the results are all either in the normal range, or just below normal (IgG). That's why free light chain test results would be useful to have -- the monoclonal protein may be completely, or mainly, light chain monoclonal proteins.

[Multibilly]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Multibilly on Wed Aug 31, 2016 9:34 am

Jim,

I think you are right. That IFE comment was about the reference range and the result could very well be a lambda-restricted finding. Nice catch.

Meagan, just so you understand, a plasma cell disorder like multiple myeloma can present in several different combinations on the IFE test. With multiple myeloma,, there is typically one monoclonal heavy chain (IgG, IgA, IgM, etc) AND one monoclonal free light chain (kappa or lambda) that shows up on the IFE (e.g. monoclonal IgG-lambda multiple myeloma). But some­times the serum heavy chains will show up as being normal (polyclonal) and only one of the free light chains will be flagged as being monoclonal (e.g. a lambda-restricted monoclonal protein finding on the IFE test). This can happen about 20% of the time in multiple myeloma patients.

The 24-hour urine test will help further confirm if you have monoclonal lambda free light chains or not. If you do have monoclonal lambda free light chains in your system, these free light chains will often show up in the 24-hour urine test as "Bence Jones proteins" (aka a urine M-spike).

Last edited by Multibilly on Wed Aug 31, 2016 1:45 pm, edited 1 time in total.

[Mharper2894]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Mharper2894 on Wed Aug 31, 2016 12:04 pm

Thank you so much for the responses!

Currently my immunologist is doing this bloodwork. I am also seeing a pulmonary doctor because I was just diagnosed with lung disease as well. ): I got pneumonia 5 times in a row from January-May of this year, followed by MRSA in my lungs. This caused permanent damage to my lungs.

I just have a feeling this is all related, and don't understand how a 22 year old is dealing with all this!

Side note, I have had a benign vascular tumor in my right thigh my whole life, and just discovered a soft tissue mass in my right ankle that is suspected to be a nerve sheathe tumor. It's been a rough year.

[Multibilly]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Multibilly on Wed Aug 31, 2016 12:34 pm

Wow, your experience would make for a a rough year for anybody, let alone a 22 year old!

If additional testing points towards something like multiple myeloma or a related plasma cell disorder, you really want to seek out a hematologist/oncologist that specializes in multiple myeloma. At that time, if you let us know what city you are in, folks on this forum can make some recommendations as to where find these specialists.

Wishing you all the best.

[Mharper2894]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by Mharper2894 on Wed Aug 31, 2016 12:36 pm

I live in a small town near Auburn, Alabama. Currently I am seeing doctors at the University of Alamaba, Birmingham (UAB). Recommendations would be appreciated!

[JimNY]

Re: 22 years old, low IgG, IFE shows 1 M lambda

by JimNY on Wed Aug 31, 2016 12:50 pm

Glad to see this thread moving along. Thanks for your comments earlier, Multibilly.

Dr. Luciano Costa is a multiple myeloma specialist at UAB who is an active researcher. He sometimes offers assistance here in this forum. Here is a link to his information at the UAB website:

http://www.uab.edu/medicine/hemonc/faculty/lucianp-j-costa-md-phd

There is also a group of multiple myeloma specialists at Emory in Atlanta; it is well regarded.

Since you're already at UAB, however, Dr. Costa is likely to be your best bet for the immediate term.