[gfro]

diagnosis after death?

by gfro on Mon Jun 10, 2013 12:20 pm

My husband had labs that said "urine negative for monoclonal Free Kappa Light chains" and "positive for free Lambda Light chains Urine IFE shows faint band in Iga." He died the next day -his heart stopped. He had been admitted to the hospital 3 days before this test for kidney and heart failure. They suspected AL amylodosis confirmed at autopsy but I wonder how it would be determined if he had multiple myeloma too? Osteoporosis showed up on x rays in the 90's when x-raying for lungs. He had an accepted smoke inhalation injury from being a wildland firefighter for the US Forest Service.and was diagnosed with extrinsic asthma" and" toxic effects of unspecified fumes, vapors, and gases" in 1987. His asthma tested mild but symptoms weren't. He used Advair till the day he died in 2009. He was in pulm. rehab when anemia was found 7 months before death and iron was added to his meds he'd been complaining of leg and joint pain the year before but it was just thought aging. .Everyone(doctors) at hospital seemed surprised when his heart stopped. Me too. He had a DNR order so he died without knowing for sure what was wrong. The kidney failure was also just a symptom and hadn't started until less than 4 months before death. i would like to know if these light chain tests indicated multiple myeloma. Amyloidosis was suspected by the time he died but no mention of multiple myeloma. I would like to know how I might find out if he had myeloma ( along with the amyloid that was confirmed) or not? Would I ask a multiple myeloma specialist to review this- would they do it? And which would have come first? Any info. would be appreciated.

[Dr. Jason Valent]

Re: diagnosis after death?

by Dr. Jason Valent on Tue Jun 11, 2013 8:44 am

Light chain amyloidosis can occur without diagnostic criteria for multiple myeloma. The diagnositc criteria for multiple myeloma that needs treatment would be 1) elevated blood calcium level, 2) kidney damage (defined as a serum creatinine over 2, 3) anemia (low red blood cell count, 4) lytic lesions (holes) in bones. The first 3 can be reviewed in his labs. The bone lesions could be looked for on x-rays done previously.

Some patients with multiple myeloma can have co-existing amyloidosis. Many patients though with amyloidosis will not necessarily meet criteria for the diagnosis of multiple myeloma.

I hope this helps. Sorry for your loss.

[gfro]

Re: diagnosis after death?

by gfro on Tue Jun 11, 2013 10:43 pm

his calium as of 2/25/09 (2 weeks belore death ) was 8.1.... thanks for responding...

he definitely had the renal failure and anemia. I am looking for x rays. Did he have to have high calcium? it was normal 8.5 on 2/13. Is low calium a deal breaker?

also he took vitamin supplements,and lamictal, advair, combivent, nexium,norvasc, and had been on CPAP. Also out of nowhere he tested positive for hep b less than 3 months before death. He had other signs- carpal tunnel type stuff but seemed all over. I would love to find a doctor who would look the labs over for me and answer this for me.....thanks