[Rory]

Anemia and an M-spike: is it always multiple myeloma?

by Rory on Mon Feb 13, 2017 9:21 pm

I am a 65-year-old male and pretty fit from a lifetime of cycling combined with a healthy diet, being tobacco-free, and drinking only modest amounts of alcohol. I would typically cycle 200 miles a week until last October.

So here is the background: About two years ago, I noticed my speed and performance were dropping. I ignored it at first, then tried fiddling with protein intake, salts, and so on. Eventually my energy levels declined to the point that I went to my doctor.

A blood test showed anemia, with my hemoglobin around 11 and low ferritin. I started taking iron tablets while the problem was investigated. Eventually a tumour was found in my colon, and I had a very successful surgery to remove part of the bowel. The feeling was that this was the cause of the anemia.

But it seems not; now four months later, I am still anemic, and my hematologist suspects multiple myeloma. A blood test showed a paraprotein level of 12.2 g/L (1.22 g/dL), which has recently increased to 19 g/L (1.9 g/dL). Other than my stubborn anemia, I am in excellent health. The basis of the suspicion appears to be the combination of the paraprotein and anemia.

My light chain kappa is 20.2, gamma 15.2. Serum albumin is a tad low at 30 g/L and serum globulin 37 g/L. Despite taking lots of iron supplements, my ferritin is stubbornly low (50) and B12 is at 252 ng/L, which is also low I think. IgA is 1.78 and IgM is 1.4, both g/L. I have had a full body x ray and bone marrow biopsy and get results next week.

I am a little confused because I can't accept my anemia is myeloma based even if that is just denial! Basically my numbers suggest MGUS but the anemia shifts the diagnosis to myeloma doesn't it?

[LuvHiking]

Re: Anemia and an M-spike: is it always multiple myeloma?

by LuvHiking on Tue Feb 21, 2017 2:35 pm

Rory - Welcome to the forum!

Wait for your bone marrow biopsy as it is a key test for myeloma. When you get the results, ask about your plasma cell percentage (3 to 5 percent is normal), and ask if the structure of the plasma cells is normal. Ask if they are doing a chromosome test (FISH panel) on your biopsy.

Approximately 1 in 20 people your age have a paraprotein, and you only have a 1% chance per year of developing myeloma for each year. Your physician is doing the correct procedure for you.

Let us know how we can help further.

[Rory]

Re: Anemia and an M-spike: is it always multiple myeloma?

by Rory on Thu Feb 23, 2017 2:20 pm

Thanks, Luvhiking. Things have moved on since I got my results. Plasma cells are 10-15%, and the hematologist has decided that my anemia is not myeloma related. My skeletal x-ray did show some marks on my shoulders although everywhere else was clear.

Yesterday I had a spine and pelvis MRI and should get results in a couple of weeks. If no bone damage is evident, she says I will probably be diagnosed as smoldering and in parallel she will try to determine what is behind the anemia.