[Opto123]

24-year-old worried I may have multiple myeloma

by Opto123 on Fri Feb 26, 2016 4:55 pm

Hello everyone,

I am a 24 year old male and have been scared of the possibility of multiple myeloma. I've been searching the Internet and the stuff that I read there is pretty frightening, so I've been trying to seek solace in the information that I've been reading here on this website. I am hoping to get more help from the wonderful people on this forum because you guys are very knowledgeable on this subject.

A little on my history, I was diagnosed with hyperthyroidism in 2014 and had my thyroid ablated with radioactive iodine. After my thyroid was dealt with, several blood tests showed that I had high parathyroid hormone consistently. My endocrinologist have been trying to figure out the cause of my high PTH, but I do not have any indications toward it being primary hyper­para­thyroid or secondary. Scans on my parathyroid showed no adenomas at all. As a matter of fact, my calcium levels are not even high, they are on the lower spectrum of the range. Typically people with high PTH experience high calcium as well. They did do a DEXA scan on me, which indicated I had osteopenia.

Well over the past 2-3 years I've noticed through my blood tests that my total protein was on the high end of the normal range and my anion gap has been low. From what I read online, high protein and low anion gap points towards multiple myeloma. Is this true? Could osteopenia also be a result of multiple myeloma, or is it possible that my high PTH is leeching the calcium out of my bones and causing the low bone density?

At my endocrinologist appointment, I expressed my concerns with him and he said he couldn't order the SPEP and IFE. He only was able to order a CBC and said that the other tests are something my PCP has to order.

Well, my PCP appointment is in April, so I am kinda left in the dark until then. I do have slight discomfort in my clavicle and sternum where my bone makes a cracking noise. My PCP said it could be costrochondritis.

Here are some of my recent blood results:

CBC

WBC 6.43 4.50 - 11.00
RBC 5.28 4.50 - 5.90
Hgb 16.0 g/dL 13.5 - 17.5 g/dL
Hematocrit 47.8 % 41.0 - 53.0 %
MCV. 90.5 fL 80.0 - 94.0 fL
MCH 30.3 pg 27.0 - 31.0 pg
MCHC 33.5 g/dL 32.0 - 36.0 g/dL
Platelet Count 193 150 - 500
MPV 11.5 fL
RDW 12.8 % 11.0 - 16.0 %
RDW-SD 42.1 %

CMP

BUN, Bld 10 mg/dL 7 - 18 mg/dL
Sodium 139 mmol/L 136 - 145 mmol/L
Potassium 4.3 mmol/L 3.5 - 5.1 mmol/L
Chloride 106 mmol/L 98 - 107 mmol/L
CO2 28 mmol/L 21 - 32 mmol/L
Glucose 92 mg/dL 74 - 106 mg/dL
Creatinine, S 0.9 mg/dL 0.6 - 1.3 mg/dL
Calcium 8.7 mg/dL 8.5 - 10.1 mg/dL
Total Protein 8.5 g/dL 6.4 - 8.2 g/dL
Albumin 4.6 g/dL 3.4 - 5.0 g/dL
Bilirubin, Tot 1.0 mg/dL 0.2 - 1.0 mg/dL
Alkaline Phos 49 U/L 50 - 136 U/L
ALT 24 U/L 12 - 78 U/L
AST 16 U/L 15 - 37 U/L
BUN/Creat Rat 11.1 mg/dL
Osmolarity 276
Anion Gap 5 mmol/L 8 - 12 mmol/L
Globulin 4 U/L
Albu/Glob Rat 1.18 mg/dL
GFR >90.0

My endocrinologist ordered an nRBC, which I don't know if it is relevant, but I'll provide the result here:

nRBC 0.0 0.0 - 1.0
NRBC, Absolute 0.00

Is there any reassurance that I can get from my blood results that it is not something like multiple myeloma? Also, come around April, what tests should I ask my PCP to do for me to confirm that it is not something like multiple myeloma?

Thank you very much for everyone's help and reading my post.

[Multibilly]

Re: 24-year-old worried I may have multiple myeloma

by Multibilly on Fri Feb 26, 2016 7:05 pm

Opto123,

Welcome to the forum.

First off, I'm not a doc, so you really need to verify all this with your docs.

While it can happen (and it has happened to folks on this forum), it is fairly uncommon to develop a plasma cell disorder such as myeloma (or even one of its early precursors, such as MGUS) at your very young age.

I'm guessing that the osteopenia could have been a result of when you had hyperthyroidism? Was this discussed? While it is counterintuitive, folks with myeloma who have bone damage tend to have elevated calcium levels.

For symptomatic multiple myeloma, you would likely see a low hemoglobin level and/or a low RBC level, an elevated calcium level, and/or an elevated creatinine level. You don't have any of these issues.

Also, note that an elevated protein level can sometimes simply be caused by dehydration. So, I would try and not jump to any conclusions about this being something like MGUS.

But since you have an elevated protein level, I would keep hydrated and then ask your doctor to run a serum immunofixation and an SPEP test just for good measure ... and also re-run your CBC and metabolic panel tests. Alternatively, you could just do the metabolic panel when you see the doctor next ... and then run the immunofixation and SPEP tests at a later time if your metabolic panel still shows an elevated protein level. But again, a doc really needs to make this call.

It might also be good to get an xray (or MRI, etc) of your affected bone areas at that time to try and figure out what's going on there. Maybe you also might use that as a reason to see your PCP earlier than April? That way, you could put your mind at rest sooner?

[JPC]

Re: 24-year-old worried I may have multiple myeloma

by JPC on Sat Feb 27, 2016 6:24 pm

Hello Opto:

Adding to what was said by Multibilly, based on your numbers, there is actually not a lot that even suggests multiple myeloma or related plasma cell disorders (however, stranger things have happened), but you do need to pursue either a general hematologist, or other appropriate discipline to get to the bottom of your issue.

Good luck