Dear Folks,
First, thanks for this resource, I'm happy to have found it.
I'm 60, female, and have felt pretty awful the last year. I have been to various doctors, no answers. Normally very active, I've had shortness of breath and muscle weakness. Normal chest x-ray and normal CT scan of chest, abdomen, and pelvis. I have pain in both hips; it wakes me up at night. A few years ago, a sclerotic lesion with indistinct margins was found in my femur; the doctor said it was "common." Numbness in my face and my thigh on right side; went to ER for TIA. I've had two small previous strokes, have atrial fib, and I'm on Coumadin (warfarin).
FInally, GP starts detailed blood work. SED rate is elevated. SPEP -- slight monoclonal spike in gamma region; albumin was below normal; beta was normal; alpha 1 and alpha 2 were at top of range. Immunofixation was recommended.
I was referred to an oncologist, who can't see me for 4 weeks. More blood tests were ordered, and I got the results; on an IEP (is that the same as SPEP?), the numbers were the same as 3 weeks earlier, but this time it was identified as IgG lambda.
My IgG was 1160; the IgA was 275; the IgM was 130 – all within normal range.
On the other blood work, the RDW is below normal range. The WBC is still in normal range, but has dropped over the last year. The anion gap is at the bottom of the range. The BUN is at the top of the range. The BUN / creatinine ratio is over the top end of normal, but the creatinine itself is normal.
I guess what I'm waiting on now is the light chain analysis so I can see the ratio.
But from the info above, given that the IgA and IgG, etc, are within normal levels, what should I be worried about ? Will a bone marrow biopsy and a skeletal x-ray be definitive?
Any comments, guidance welcomed. Thank you!
Forums
5 posts
• Page 1 of 1
Re: Blood test results - what do they mean & next steps?
Hi DungenessCrab,
It could very well be that you have a very early stage of multiple myeloma known as MGUS, and you may live the rest of your life without requiring treatment of the disease itself. So, try not to fret. A lot of folks go through life with MGUS and never know they have it.
What is your calcium and hemoglobin level at? What was the actual value of your monoclonal spike (please include the units of measure)?
Based on the tests you have so far, a Freelite (free light chain) assay would indeed be a good next step.
A Freelite assay is also a good test for you to get since there are versions of this disease where only a free light chain level is affected in one's blood serum and the immunoglobulin levels are hardly affected or not affected at all.
There are also versions of the disease where both the immunoglobulin and free light chain levels are unaffected or are affected only slightly. In that case, one definitely needs a bone marrow biopsy to detect the disease.
Based on the free light chain results, a bone marrow biopsy might be the right next step (which is indeed the definitive test for any stage of multiple myeloma). You might also consider getting imaged (PET/CT or MRI) at that point, as that will tell you if you potentially have any bone damage. I would personally push for a whole-body PET/CT over a skeletal survey (whole-body XRAY) for initial diagnosis, but that's just me.
But most importantly, do take the time to seek out a multiple myeloma specialist. If you let us know approximately where you live, folks on this forum can make some recommendations. A multiple myeloma specialist is best able to handle the staging and interpretation of the various tests.
Lastly, was your IEP (immunoelectrophoresis) a serum or urine test? A serum IFE (immunofixation electrophoresis) is the typical serum test that tells you whether you have any monoclonal protein and what type it is, but doesn't measure the actual amount of the monoclonal protein. An IEP is a test that is similar to the IFE.
On the other hand, an SPEP measures the amount of monoclonal protein in one's blood and will often reference the results of the IFE to tell you the kind of monoclonal protein that was measured (that is, the SPEP will tell you have a monoclonal spike of x g/dL and use the IFE results to tell you that is of type IgG lambda).
Hope this helps.
It could very well be that you have a very early stage of multiple myeloma known as MGUS, and you may live the rest of your life without requiring treatment of the disease itself. So, try not to fret. A lot of folks go through life with MGUS and never know they have it.
What is your calcium and hemoglobin level at? What was the actual value of your monoclonal spike (please include the units of measure)?
Based on the tests you have so far, a Freelite (free light chain) assay would indeed be a good next step.
A Freelite assay is also a good test for you to get since there are versions of this disease where only a free light chain level is affected in one's blood serum and the immunoglobulin levels are hardly affected or not affected at all.
There are also versions of the disease where both the immunoglobulin and free light chain levels are unaffected or are affected only slightly. In that case, one definitely needs a bone marrow biopsy to detect the disease.
Based on the free light chain results, a bone marrow biopsy might be the right next step (which is indeed the definitive test for any stage of multiple myeloma). You might also consider getting imaged (PET/CT or MRI) at that point, as that will tell you if you potentially have any bone damage. I would personally push for a whole-body PET/CT over a skeletal survey (whole-body XRAY) for initial diagnosis, but that's just me.
But most importantly, do take the time to seek out a multiple myeloma specialist. If you let us know approximately where you live, folks on this forum can make some recommendations. A multiple myeloma specialist is best able to handle the staging and interpretation of the various tests.
Lastly, was your IEP (immunoelectrophoresis) a serum or urine test? A serum IFE (immunofixation electrophoresis) is the typical serum test that tells you whether you have any monoclonal protein and what type it is, but doesn't measure the actual amount of the monoclonal protein. An IEP is a test that is similar to the IFE.
On the other hand, an SPEP measures the amount of monoclonal protein in one's blood and will often reference the results of the IFE to tell you the kind of monoclonal protein that was measured (that is, the SPEP will tell you have a monoclonal spike of x g/dL and use the IFE results to tell you that is of type IgG lambda).
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Blood test results - what do they mean & next steps?
Dear Multibilly,
Thank you so much for such a thoughtful and detailed answer. I really appreciate it.
In answer to your questions, my hemoglobin was 13.7, in a normal range. My calcium was 9.5; adjusted calcium 9.6, also within normal limits.
My monoclonal spike was 1.11 g/dL. Everything has been a blood test, no urine testing.
Just got back the free light chain results:
Kappa 1.18 mg/dL
Lambda 1.76 mg/dL
Kappa / Lambda Ratio 0.67
all of which are in normal ranges.
I was happy to see the readings were all normal, but also took note of your statement it doesn't rule out myeloma if I understood you correctly.
I live in the Northwest, and am waiting for an appointment for a myeloma specialist at Oregon Health Science University. And now I've read about getting a PET/CT scan and understand why-instead of just a bone x-ray. Next is bone marrow biopsy, I guess. I feel like I know what to talk to the doctor about , or at least ask why this instead of this.
I really appreciate your help so much. Any other input, in response to what I've set forth above – I'm grateful for the help.
Thank you so much for such a thoughtful and detailed answer. I really appreciate it.
In answer to your questions, my hemoglobin was 13.7, in a normal range. My calcium was 9.5; adjusted calcium 9.6, also within normal limits.
My monoclonal spike was 1.11 g/dL. Everything has been a blood test, no urine testing.
Just got back the free light chain results:
Kappa 1.18 mg/dL
Lambda 1.76 mg/dL
Kappa / Lambda Ratio 0.67
all of which are in normal ranges.
I was happy to see the readings were all normal, but also took note of your statement it doesn't rule out myeloma if I understood you correctly.
I live in the Northwest, and am waiting for an appointment for a myeloma specialist at Oregon Health Science University. And now I've read about getting a PET/CT scan and understand why-instead of just a bone x-ray. Next is bone marrow biopsy, I guess. I feel like I know what to talk to the doctor about , or at least ask why this instead of this.
I really appreciate your help so much. Any other input, in response to what I've set forth above – I'm grateful for the help.
Re: Blood test results - what do they mean & next steps?
DC,
Based on your numbers and without having the benefit of any bone marrow biopsy results, this does sound like MGUS (which only has about 1% chance per year of progressing to symptomatic multiple myeloma). But a doc really needs to make that call.
You might want to be specifically searching out Dr. Emma Scott at OHSU. At least, I've heard her name come up a few times before on this forum.
Best of luck to you.
Based on your numbers and without having the benefit of any bone marrow biopsy results, this does sound like MGUS (which only has about 1% chance per year of progressing to symptomatic multiple myeloma). But a doc really needs to make that call.
You might want to be specifically searching out Dr. Emma Scott at OHSU. At least, I've heard her name come up a few times before on this forum.
Best of luck to you.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Blood test results - what do they mean & next steps?
Many, many thanks, Multibilly. And my good thoughts and best wishes to you .
5 posts
• Page 1 of 1