I'm new here and looking for information on monoclonal gammopathy as I am a little confused by recent lab results.
Let me start by saying I have been under the care of a hematologist for many years due to recurrent pelvic DVT/PEs and am on lifelong anticoagulant treatment. My hematologist is a professor in his field, very well respected, and I quite like him, although he is a bit old school in his doctor/patient relationship with little sharing of information.
My rheumatologist ran blood work recently, results below
Hb 85 (115-160) g/L
RCC 3.17 (3.80-4.80)
Hct 0.26 (0.37-0.47)
MCH 26.7 (27.0-32.0)
RDW 16.8 (9.0-15.0)
Ferritin 7 ug/L (30-300)
Iron 2 umol/L (9-30)
Transferrin Sat 2% (13-45)
IgG 5.3 (5.8-13.7)
IgM 5.05 (0.30-1.70)
Serum Free Light Chains
Kappa 20.3 (3.3-19.4)
Lambda 6.7 (5.7-26.3)
Kappa/lambda ratio 3.03 (0.26-1.65)
No paraproteins detected in serum or urine.
Urine protein/creatinine ratio up a little at 27 (<13)
Free light chain study was run again 8 weeks after the first and results were slightly increased from the last check:
Kappa 23.6 (3.3-19.4)
Lambda 6.9 (5.7-26.3)
Kappa/lambda ratio 3.42 (0.26-1.65)
Each time the pathology report states results are "consistent with a monoclonal gammopathy. Multiple myeloma, AL amyloidosis, and some B-cell disorders should be considered."
My rheumatologist sent me to my hematologist to review the results of the bloodwork she had run, thinking the worst, but my hematologist said very little about the free light chain and ratio levels, and was more concerned about the anemia. Monoclonal gammopathy of any sort was not mentioned by him to me.
I'm left wondering should I be seen by an oncologist in case further testing needs to be done? Or do my results mean no further investigating is warranted?
If you have made it to the bottom of this very long winded message, my thanks and I look forward to hearing your opinions : )
Rebecca
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Re: Lab results consistent with a monoclonal gammopathy
Rebecca,
I am not a doctor and do not know anything about DVT/PE and what significance it might have for a MGUS or smoldering myeloma diagnosis. That said, I cannot understand why you do not immediately make an appointment with a myeloma specialist or, at the very least, a doctor who can discuss with you fully and to your satisfaction what your test results mean.
It appears that you have several abnormal test results. (Did you inadvertently omit to tell us the IgA result?) In particular, your hemoglobin, as you indicated, seems low. I wonder whether you are often unusually tired and out of breath. Your serum light chains and kappa// lambda ratio are also out of whack, although not terribly so. Still, you deserve a thorough explanation from your treating doctor.
I would not let this go. You need to learn, too, what the high IgM means for you. This result seems quite high. (I should say that I started myeloma treatment when my kappa/lambda ratio was lower than yours and my hemoglobin was low at 10.8.)
I am not a doctor and do not know anything about DVT/PE and what significance it might have for a MGUS or smoldering myeloma diagnosis. That said, I cannot understand why you do not immediately make an appointment with a myeloma specialist or, at the very least, a doctor who can discuss with you fully and to your satisfaction what your test results mean.
It appears that you have several abnormal test results. (Did you inadvertently omit to tell us the IgA result?) In particular, your hemoglobin, as you indicated, seems low. I wonder whether you are often unusually tired and out of breath. Your serum light chains and kappa// lambda ratio are also out of whack, although not terribly so. Still, you deserve a thorough explanation from your treating doctor.
I would not let this go. You need to learn, too, what the high IgM means for you. This result seems quite high. (I should say that I started myeloma treatment when my kappa/lambda ratio was lower than yours and my hemoglobin was low at 10.8.)
Re: Lab results consistent with a monoclonal gammopathy
Hello Buttrfluttr,
I agree with Mrozdav, particularly with the need to find a doctor who explains your lab results for you and lets you know what the most likely explanation is for them.
I will add that one of the critical results you shared is the line:
If this is based on extensive testing, it would mean that your elevated IgM is most likely being caused by something other than a monoclonal gammopathy.
However, was one of the tests you had done a serum immunofixation electrophoresis (IFE, or IFX)?
The IFE is the most accurate way to test for a monoclonal gammopathy involving elevated IgG, IgA, or IgM levels. It is more accurate than the more typical serum or urine protein electrophoresis testing (SPEP and UPEP tests).
You should know that one type of monoclonal gammopathy that can cause elevated IgM levels is Waldenstroms macroglobulinaemia. Wikipedia has some basic information on the disorder, which is often accompanied by anaemia.
Cheers!
I agree with Mrozdav, particularly with the need to find a doctor who explains your lab results for you and lets you know what the most likely explanation is for them.
I will add that one of the critical results you shared is the line:
No paraproteins detected in serum or urine
If this is based on extensive testing, it would mean that your elevated IgM is most likely being caused by something other than a monoclonal gammopathy.
However, was one of the tests you had done a serum immunofixation electrophoresis (IFE, or IFX)?
The IFE is the most accurate way to test for a monoclonal gammopathy involving elevated IgG, IgA, or IgM levels. It is more accurate than the more typical serum or urine protein electrophoresis testing (SPEP and UPEP tests).
You should know that one type of monoclonal gammopathy that can cause elevated IgM levels is Waldenstroms macroglobulinaemia. Wikipedia has some basic information on the disorder, which is often accompanied by anaemia.
Cheers!
Re: Lab results consistent with a monoclonal gammopathy
Rebecca, Ian's points are well taken. He has reminded me about the important IFE test. In my own case, for several months after I started treatment, my SPEP showed no M-spike, but the IFE did show the continuing presence of myeloma. Accordingly, you should ask your doctor about the IFE, if you have not had this test already.
Re: Lab results consistent with a monoclonal gammopathy
I appreciate your input, mrozdav and Ian.
mrozdav – To say I have been feeling tired is an understatement : ) I required a blood transfusion last July because of low hemoglobin, which helped my level up to 100, but only temporarily. I am now having monthly iron infusions but am still in the anemic range.
Ian – I am not certain if an IFE was done. The paraprotein thing is still confusing me somewhat as I try to wrap my head around unfamiliar medical terms. Is Bence Jones Protein a paraprotein? (A urine sample was positive for Bence Jones). And are paraproteins evident in light chain myeloma?
mrozdav – To say I have been feeling tired is an understatement : ) I required a blood transfusion last July because of low hemoglobin, which helped my level up to 100, but only temporarily. I am now having monthly iron infusions but am still in the anemic range.
Ian – I am not certain if an IFE was done. The paraprotein thing is still confusing me somewhat as I try to wrap my head around unfamiliar medical terms. Is Bence Jones Protein a paraprotein? (A urine sample was positive for Bence Jones). And are paraproteins evident in light chain myeloma?
Re: Lab results consistent with a monoclonal gammopathy
Rebecca:
Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine. It may suggest multiple myeloma or Waldenstrom's macroglobulinemia. Bence Jones proteins are not normally present in healthy urine samples.
I do not know much about Waldenstrom's macroglobulinemia, but the husband of an acquaintance of mine was diagnosed with it after it was discovered that he had elevated IgM and severe anemia. He was started on appropriate treatments and seems to be doing well.
From the information you have provided, I urge you again to consult a myeloma specialist. If you tell our community where you live, someone will no doubt be able to suggest some cancer centers or even specialists in your area (in case you need such a recommendation).
Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine. It may suggest multiple myeloma or Waldenstrom's macroglobulinemia. Bence Jones proteins are not normally present in healthy urine samples.
I do not know much about Waldenstrom's macroglobulinemia, but the husband of an acquaintance of mine was diagnosed with it after it was discovered that he had elevated IgM and severe anemia. He was started on appropriate treatments and seems to be doing well.
From the information you have provided, I urge you again to consult a myeloma specialist. If you tell our community where you live, someone will no doubt be able to suggest some cancer centers or even specialists in your area (in case you need such a recommendation).
Re: Lab results consistent with a monoclonal gammopathy
I appreciate the feedback and advice!
It helped me realise I really needed to follow up on the lab results and that my uncertainty in my thrombosis specialist knowing what the lab reports indicated was actually well founded. I saw my family doctor today and have been referred to a myeloma specialist for further work up. Apparently a bone marrow biopsy and body scan is the next step.
In the meantime I thought I'd ask if blurring vision could be a part of the monoclonal gammopathy. I am having awful issues with this at the moment.
It helped me realise I really needed to follow up on the lab results and that my uncertainty in my thrombosis specialist knowing what the lab reports indicated was actually well founded. I saw my family doctor today and have been referred to a myeloma specialist for further work up. Apparently a bone marrow biopsy and body scan is the next step.
In the meantime I thought I'd ask if blurring vision could be a part of the monoclonal gammopathy. I am having awful issues with this at the moment.
Re: Lab results consistent with a monoclonal gammopathy
Further to this thread, I was seen by a specialist hemotologist a little over a week ago who decided to re-run all the previous pathology tests using his own lab.
Not all results are back yet, but the EPP and IFE are. I am not sure how to interpret a part of the electrophoresis result and would like help if someone could offer input:
Band 3 g/L
Is this the size of the band? Is 3 a low amount for IgM related kappa paraprotein?
The serum immunofixation results are as follows:
"IFE shows a broad band of anti M positivity in the mid gamma region. There is corresponding kappa light chain positivity, with much less corresponding lambda positivity. An IgM kappa paraprotein is probable."
I see my hematologist again in two weeks for follow-up. At my last appointment I was told I could have myeloma, an indolent lymphoma, or a type of leukemia, but there was the chance the elevated IgM might be polyclonal despite the raised kappa free light chain/ratio results. I'm assuming the immunofixation results now rule out a polyclonal cause?
Not all results are back yet, but the EPP and IFE are. I am not sure how to interpret a part of the electrophoresis result and would like help if someone could offer input:
Band 3 g/L
Is this the size of the band? Is 3 a low amount for IgM related kappa paraprotein?
The serum immunofixation results are as follows:
"IFE shows a broad band of anti M positivity in the mid gamma region. There is corresponding kappa light chain positivity, with much less corresponding lambda positivity. An IgM kappa paraprotein is probable."
I see my hematologist again in two weeks for follow-up. At my last appointment I was told I could have myeloma, an indolent lymphoma, or a type of leukemia, but there was the chance the elevated IgM might be polyclonal despite the raised kappa free light chain/ratio results. I'm assuming the immunofixation results now rule out a polyclonal cause?
8 posts
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