[Sandrasongbird]

Slightly abnormal free light chain ratio with low ferritin

by Sandrasongbird on Sat Dec 05, 2015 12:26 am

I am new to the Myeloma Beacon and to this forum. I have anemia, low RBC, hip pain, and recently had blood work. I have not been diagnosed with MGUS, multiple myeloma, or smol­dering multiple myeloma. But my doctor ran many tests, including the free light chain assay and serum protein electrophoresis and urine test for Bence Jones protein.

The electrophoresis was negative as was the urine protein. But my FLC ratio was a little ab­normal being 1.81. The absolute values of kappa and lambda were in normal range, however.

Should I be concerned about this ratio? I'm wondering if it's a mistake or if it really means any­thing significant.

I also have low ferritin. My doctor is treating the anemia with iron infusion as I am not able to take oral iron. If it helps to raise my RBC and iron stores, but my FLC ratio remains abnormal, is this a concern?

[Multibilly]

Re: Slightly abnormal free light chain ratio with low ferrit

by Multibilly on Sat Dec 05, 2015 9:22 am

Welcome to the forum!

First, I'm not a doctor, so a doctor should really make a call on this situation.

Technically, a normal kappa + normal lambda and a high FLC ratio can mean the presence of a monoclonal gammopathy with bone marrow suppression. BUT I'm not entirely sure that would be indicated in your situation given your FLC ratio is just barely over the upper limit and all your other tests were negative.

Has your doctor ordered an MRI of your hips to help determine the cause of the hip pain?

Did the doctor also run a serum immunofixation test? That would be a very accurate and inexpensive way to determine if any of the proteins in your blood were monoclonal or not. Are your serum calcium and creatinine levels also in the normal range?

To be on the safe side, you might want to consider a consult with a multiple myeloma specialist to see if any further tests are warranted (bone marrow biopsy, etc). There are less common forms of multiple myeloma where the serum and urine markers are barely impacted, if they are impacted at all - and the disease will only show up in one's bone marrow. If you let us know what city you are in, folks can make some recommendations as to where to find these specialists.

I do want to underscore that I don't think it is likely that you have a monoclonal gammopathy based on what you presented here. But I think that getting to the root cause of your hip pain will be important to understand before completely ruling out a monoclonal gammopathy.