[Pattimay]

Can someone please help explain for my dad

by Pattimay on Fri Nov 11, 2011 2:31 pm

My dad has been on 6mp an immunsuppresent for ulcerative colitis for about two years. He has had no flairs on this but the med causes low white count and his liver tests are always abnormal. He also gets lungs infections due to Bronchiostasis . So being on an immunsuppresent is not helping. I begged my mom to take my dad to a hemotologist just to make sure it's okay to stay on the 6mp. He always had a low white count on this med and his gastro wasn't concerned. Now his wbc is normal but his rbc, hgb, cht is all low and his mcv is high. Ferritin normal and normal b12 and folate. His AST, Alt, GGT is all high . Thinking this is from the 6mp. What I'm concerned about is his IGG. It is 1980 normal being as high as 1560. Everything else is normal. Hemotologist did the 24 hr. urine protein electrophoresis test. The results were:
Total protein 10 normal 5-25
Albumin 100.0 Normal 100.00
Alpha 1 0.0 normal 0.0
Alpha 2 0.0 normal 0.0
Beta 0.0 normal 0.0
gamma 0.0 normal 0.0
Interpretations no paraprotein detected
IFE not detected
Please . Is this a good thing and could it mean not having multiple myloma. When I looked up high igg it always says that's what it is from. Hemotologist wants a bone marrow test. He has no symptoms of anything. Forgot to say his A/g is 1.2 and globulin is 3.6 . Thank you for any understanding of this all. My mom and I are very concerned.

[Dr. Adam Cohen]

Re: Can someone please help explain for my dad

by Dr. Adam Cohen on Sun Nov 13, 2011 10:37 pm

Multiple myeloma (and the related pre-malignant disorder MGUS) can cause a high IgG level, but there are a number of non-malignant conditions that can cause elevated IgG as well. It's important to determine is if the increased IgG is "monoclonal" (meaning it's the same immunoglobulin produced over and over again, as seen in myeloma or MGUS), or "polyclonal" (meaning it's high due to overproduction of multiple different immunoglobulins, which can be caused by autoimmune diseases like ulcerative colitis, chronic liver disease, and acute or chronic infections, to name a few).
The fact that the urine protein electrophoresis and urine immunofixation were negative goes against myeloma, but he needs to have a serum protein electrophoresis, serum immunofixation, and serum free light chains done as well. If these are all negative for a monoclonal protein, then myeloma is extremely unlikely and other causes for the high IgG should be explored.

[Pattimay]

Re: Can someone please help explain for my dad

by Pattimay on Mon Nov 14, 2011 3:49 pm

Thank you so much Doctor for responding. Don't know why the hemotolgist wants a bone marrow done without doing those other tests first. He has to go through so much with the constant colonoscopys and would hate for him to have to go through that test as well. Doctor said for peace of mind. He went off the 6mp and keeping fingers crossed that he stays in remission from the uc. Just wondering if the constant use of amoxocilin for the brociostasis can cause the increase in his IGG?? Thank you so much again.

[Dr. Peter Voorhees]

Re: Can someone please help explain for my dad

by Dr. Peter Voorhees on Tue Nov 15, 2011 4:39 am

Dear Pattimay,

Your father's physician may have some of this information already. If an SPEP was performed, we should be able to determine if any of that IgG antibody is monoclonal or all just polyclonal. If the red cell parameters (hemoglobin, etc) improve off 6-MP and the SPEP and serum immunofixation show no evidence of a monoclonal antibody (i.e. M spike or M protein), a marrow could be deferred. If a respectable M spike is present and/or if the anemia does not get better off 6-MP, I would support a bone marrow biopsy.

Good luck!

Pete V.

[Pattimay]

Re: Can someone please help explain for my dad

by Pattimay on Tue Nov 15, 2011 6:08 pm

Thanks again Doctor. Sorry just one more question. I think I will next time go with my mom and dad to hemo because they don't understand all these tests and what they mean. Just would like to know if the 24 hr urine test that hemo gave is as reliable as the serum test. I picked up results as I wrote them with my first post and did not see anything mentioned on paper about results being mono or poly. Just tht the paraprotein was negative. I know mono would mean more likely myloma. Thank you again.

[Dr. Peter Voorhees]

Re: Can someone please help explain for my dad

by Dr. Peter Voorhees on Wed Nov 16, 2011 3:40 am

There is no detectable M-spike, M protein, monoclonal protein/antibody -- choose your terminology -- in the urine. As such, the crucial question is whether or not the elevated IgG in the serum is due to the presence of a monoclonal IgG or polyclonal IgG.

Good luck and let us know how it goes!

Pete V.