I am just trying to learn and understand what all my recent blood work is showing. I am seeing the hematologist May 8th to go over all the blood work / tests. He said he wanted to rule out multiple myeloma. I'm hoping to read up and understand as much as I can so I can ask the right questions when I see the doctor. Any help would be appreciated.
So far I have had: blood work, long bone Xray and an MRI for a shoulder injury that started all of this:
MRI: Marrow edema in bones about the acrmioclavical joint representing bones reactive changes to acriminal calculate arthropathy, Possible non displaced fracture of the distal clavicle, mild diffused signal abnormality, partial replacement of normal marrow by more cellular marrow.
X ray: There are degenerative changes throughout the spine. There is calcific density adjacent to the humeral head on the left side in the region of the rotator cuff tendon suggesting calcific tendinitis. Patient is undergoing fusion of the L5-S1 level. There are no lytic or sclerotic bony lesions.
Blood work: CBC normal, normal BUN (14), calcium normal (9.1) creatinine (0.9)
Creatine clearance: Last tested was when I was recently hospitalized in October 2013 with acute pancreatitis causing the need for a gallbladder surgery and then developing hospital acute bilateral pneumonia with elevated BMP HF cardiac enzymes and sepsis. It was low entire time in the hospital and at discharge my creatininee clearance was L 58. (90-130).
SED rate (ESR) 34 (0-20)
C Reactive Protein 8.2 (0-3)
IgA 522 (70-420)
IgM 60.8 (45-245)
IgG 1050 (650-1575)
Ig kappa light chain 37.96 (3.0-19.40)
Ig lambda light chain 18.26 (5.71-26.30)
Kappa / lambda fluid c ratio 2.08 (0.26-1.65)
Still waiting on protein electrophoresis separates proteins test results.
Current health status includes:
Recurrent sinus infections, fatty liver, osteoarthritis with an ill-defined rheumatological arthritis, 2 small lung nodules. pulmonary hypertension with left ventricle diastolic dysfunction / heart failure. My lung function levels have declined over the past year. I am now on overnight oxygen. I also had thyroid cancer and recently had a slightly elevated thyroglobulin test come back. Scheduled to have another test and neck ultrasound in June. I am also scheduled for more lung function tests in June.
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Re: Do these lab results suggest multiple myeloma?
Hi Patti,
Welcome to the forum. You really need the results of your immunofixation (IFE) and serum protein electrophoresis (SPEP) tests to determine if any of these lab results may be attributable to multiple myeloma (that is, whether the just slightly elevated IgA level and slightly elevated Kappa/Lambda ratio are due to multiple myeloma). It sounds like you will be getting those test results soon.
But you mention that you have "2 small lung nodules"? Were these "nodules" biopsied and were they confirmed to be due to multiple myeloma? What has your doctor said about dealing with these two nodules?
Welcome to the forum. You really need the results of your immunofixation (IFE) and serum protein electrophoresis (SPEP) tests to determine if any of these lab results may be attributable to multiple myeloma (that is, whether the just slightly elevated IgA level and slightly elevated Kappa/Lambda ratio are due to multiple myeloma). It sounds like you will be getting those test results soon.
But you mention that you have "2 small lung nodules"? Were these "nodules" biopsied and were they confirmed to be due to multiple myeloma? What has your doctor said about dealing with these two nodules?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do these lab results suggest multiple myeloma?
Thanks for responding. The lung nodules have not been confirmed or biopsied. They only have been detected in a CT. 6 millimeter and 4 millimeter.
My first appointment was a very brief appointment. He said that, since my CBC was normal, his hunch is that it will turn out as nothing but because of the MRI results he wanted to run some blood tests and a long bone series of X-rays. So most of my appointment was sent at the lab and radiology.
I am still waiting for the SPEP test. That was ordered from my primary before I saw the hematologist. The lab slip came in this week so I finally got to the lab and they said the results will post online by Tuesday. All of the hematologist blood tests were run in the hospital lab and I was not told what he was running in terms of blood tests. As the results post online, then I am able to see what test and the result. I know that he also ran a COMP METABOLIC PANEL / ONCOLOGY panel which showed that all my levels are within the normals. So I am not even sure if he ran an immunofixation (IFE) test.
I guess I will watch out to see if it posts. He did say that one test could take a while and was not sure if it would be in by the time we have our follow up. And so the wait begins.
My first appointment was a very brief appointment. He said that, since my CBC was normal, his hunch is that it will turn out as nothing but because of the MRI results he wanted to run some blood tests and a long bone series of X-rays. So most of my appointment was sent at the lab and radiology.
I am still waiting for the SPEP test. That was ordered from my primary before I saw the hematologist. The lab slip came in this week so I finally got to the lab and they said the results will post online by Tuesday. All of the hematologist blood tests were run in the hospital lab and I was not told what he was running in terms of blood tests. As the results post online, then I am able to see what test and the result. I know that he also ran a COMP METABOLIC PANEL / ONCOLOGY panel which showed that all my levels are within the normals. So I am not even sure if he ran an immunofixation (IFE) test.
I guess I will watch out to see if it posts. He did say that one test could take a while and was not sure if it would be in by the time we have our follow up. And so the wait begins.
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
Re: Do these lab results suggest multiple myeloma?
Patti,
An immunofixation test is almost always run in conjunction with the serum protein electrophoresis test and the IFE test may simply be "implied" in your upcoming test results. In any case, the serum protein electrophoresis test will be telling. I agree that nothing in your current lab test results is screaming a diagnosis of a monoclonal gammopathy (but I'm not a doc by any stretch of the imagination).
An immunofixation test is almost always run in conjunction with the serum protein electrophoresis test and the IFE test may simply be "implied" in your upcoming test results. In any case, the serum protein electrophoresis test will be telling. I agree that nothing in your current lab test results is screaming a diagnosis of a monoclonal gammopathy (but I'm not a doc by any stretch of the imagination).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do these lab results suggest multiple myeloma?
Thank you again for the information. I am hoping that my SPEP comes out fine so perhaps we can rule this out. But then I still have to wonder about the kappa light chain slight elevation and the slight elevation of the ratio. What else can cause that? I guess that might be a good question to ask the doctor on Friday.
In my search I did come across light chain deposition chain (LCDD). Have you heard of that? It mentioned a cardiac manifestation that stated an echocardiography and cardiac catheterization may reveal diastolic dysfunction and decreased myocardial compliance. which mine did. Says it can include restrictive cardiomyopathy, cardiomegaly, congestive heart failure, and arrhythmias.
I find this interesting since the doctors have yet to figure out what brought on my quick development of heart and lung problems. I have always questioned this, since before I had thyroid cancer, my health was good. I had my thyroid removed in 2013 and then had the radioactive iodine radiation treatment. Then, less than a month later, I was in the hospital with chest pains. The next thing I knew, I was diagnosed with pulmonary hypertension and left ventricle diastolic dysfunction. Sure has been a fun few years.
Thanks again. I will post again after the blood tests come in. Positive thoughts, right?
In my search I did come across light chain deposition chain (LCDD). Have you heard of that? It mentioned a cardiac manifestation that stated an echocardiography and cardiac catheterization may reveal diastolic dysfunction and decreased myocardial compliance. which mine did. Says it can include restrictive cardiomyopathy, cardiomegaly, congestive heart failure, and arrhythmias.
I find this interesting since the doctors have yet to figure out what brought on my quick development of heart and lung problems. I have always questioned this, since before I had thyroid cancer, my health was good. I had my thyroid removed in 2013 and then had the radioactive iodine radiation treatment. Then, less than a month later, I was in the hospital with chest pains. The next thing I knew, I was diagnosed with pulmonary hypertension and left ventricle diastolic dysfunction. Sure has been a fun few years.
Thanks again. I will post again after the blood tests come in. Positive thoughts, right?
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
Re: Do these lab results suggest multiple myeloma?
Hi Patti,
Many folks on this forum are familiar with LCDD and some also have this disease. The IFE test that will likely accompany your SPEP will tell you if any of your serum proteins (including your free light chains) are monoclonal in nature. Knowing if any of your serum proteins are monoclonal will be key in starting to determine if something like LCDD, amyloidosis, multiple myeloma, etc. may be at play.
Your immunogloblulins and free light chains aren't super-elevated, so there can be other explanations for them being elevated, including inflammation. But you first need to figure out if they are monoclonal (abnormal) or polyclonal (healthy) in nature.
Try to take a deep breath while you wait for the results to come in. Trying to second guess all the possibilities before you have more complete test results can lead you down a lot of false paths.
Many folks on this forum are familiar with LCDD and some also have this disease. The IFE test that will likely accompany your SPEP will tell you if any of your serum proteins (including your free light chains) are monoclonal in nature. Knowing if any of your serum proteins are monoclonal will be key in starting to determine if something like LCDD, amyloidosis, multiple myeloma, etc. may be at play.
Your immunogloblulins and free light chains aren't super-elevated, so there can be other explanations for them being elevated, including inflammation. But you first need to figure out if they are monoclonal (abnormal) or polyclonal (healthy) in nature.
Try to take a deep breath while you wait for the results to come in. Trying to second guess all the possibilities before you have more complete test results can lead you down a lot of false paths.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do these lab results suggest multiple myeloma?
Patti,
Have your doctors considered primary amyloidosis? It is notorious for causing cardiac problems! It can also cause significant lung problems. It causes a high light chain count, but without the bone findings of myeloma. You definitely NEED to ask about this. Studies of any biopsies you have must include "Congo red stain", which is not necessarily commonly ordered and is specific for amyloid fibrils.
If you have other specific questions about amyloidosis, feel free to private message me!
Have your doctors considered primary amyloidosis? It is notorious for causing cardiac problems! It can also cause significant lung problems. It causes a high light chain count, but without the bone findings of myeloma. You definitely NEED to ask about this. Studies of any biopsies you have must include "Congo red stain", which is not necessarily commonly ordered and is specific for amyloid fibrils.
If you have other specific questions about amyloidosis, feel free to private message me!
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Do these lab results suggest multiple myeloma?
Thanks Tracey, I did see that when looking up all of this. I only saw the hematologist 1 time and we really did not talk much. I see him tomorrow for a follow up and I am going to inquire what can cause the light chains to come in elevated. Everything I could find brings me right back to having a possible problem with your plasma cells.
I did just get my SPEP results. No M-spike, so that must be good. But the albumin was low and the Alpha 2 % and Beta % were elevated. Overall, my protein was within normal levels (6.8) as were the other levels checked.
Albumin % 48.01 (50-70) L
Albumin 3.6 (3.4-4.7) L
Alpha 2 % 10.71 (4.5-10.2) H
Beta % 19.52 (4.8-13) H
Beta 1.33 (0.6-1.2)
Even though these levels do not look too concerning, I will want clarification. So I will ask for more possibilities, especially since I do have cardiac (left ventricle diastolic dysfunction) and lung issues (pulmonary hypertension).
I have had those lung nodules for a few years. The pulmonary specialist is taking a watch-and-see and has not done anymore tests on them other than a CT.
My pulmonary functions declined from October 2013 to June 2014. I have a moderate gas exchange issue with reduce diffusion and an obstruction. Recently, I just ended up on overnight oxygen because of dropping of oxygen levels. They are running more lung function tests in June. So we will find out what is up then.
I also have had an elevated SED rate and C reactive protein for a while for an ill-defined inflammatory arthritis. I will see the rheumatologist in June.
Looks like a busy June, since I also need shoulder surgery. But I need to deal with one problem at a time. I am looking forward to hearing what the doctor has to say tomorrow.
Thanks again, Patti
I did just get my SPEP results. No M-spike, so that must be good. But the albumin was low and the Alpha 2 % and Beta % were elevated. Overall, my protein was within normal levels (6.8) as were the other levels checked.
Albumin % 48.01 (50-70) L
Albumin 3.6 (3.4-4.7) L
Alpha 2 % 10.71 (4.5-10.2) H
Beta % 19.52 (4.8-13) H
Beta 1.33 (0.6-1.2)
Even though these levels do not look too concerning, I will want clarification. So I will ask for more possibilities, especially since I do have cardiac (left ventricle diastolic dysfunction) and lung issues (pulmonary hypertension).
I have had those lung nodules for a few years. The pulmonary specialist is taking a watch-and-see and has not done anymore tests on them other than a CT.
My pulmonary functions declined from October 2013 to June 2014. I have a moderate gas exchange issue with reduce diffusion and an obstruction. Recently, I just ended up on overnight oxygen because of dropping of oxygen levels. They are running more lung function tests in June. So we will find out what is up then.
I also have had an elevated SED rate and C reactive protein for a while for an ill-defined inflammatory arthritis. I will see the rheumatologist in June.
Looks like a busy June, since I also need shoulder surgery. But I need to deal with one problem at a time. I am looking forward to hearing what the doctor has to say tomorrow.
Thanks again, Patti
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
Re: Do these lab results suggest multiple myeloma?
Just a quick update: saw the hematologist / oncologist yesterday and he diagnosed me with MGUS. Still processing.
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
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