I am confused. I had testing done at the end of January showing:
Free kappa - 182 (normal 3.3 - 19.4 )
Free lambda - 10.3 (0.24 - 6.66)
Free kappa/lambda - 17.64
Then in March with no treatment it was
Kappa - 23.1
Lambda - 14.6
Kappa/lambda - 1.58
My question is: Why the difference? Same lab.
I do have anemia and a compression fracture in my back, which the doctor says I shouldn't have, and many, many urinary tract infections. Have not seen the hematologist yet. They are considering multiple myeloma.
Forums
9 posts
• Page 1 of 1
Re: Drop in kappa-lambda ratio with no treatment?
Hi Mona,
Welcome to the forum. A few things:
1. You didn't include the units of measure and the normal ranges on your March test results Are you sure you are comparing the same type of light chain tests? There are serum FREE light chain tests and serum TOTAL light chain tests, and these are very different tests that have different normal ranges. But if the tests are indeed both serum free light chain tests, it's not that uncommon for there to be a lab error on these kinds of tests. You therefore might want to get re-tested.
3. Do you know what your M-spike is from your serum protein electrophoresis (SPEP) test is, what your IgG, IgA and IgM levels are, and what the results of your serum immunofixation test are?
4. You say you are anemic. Just how low is your hemoglobin level?
5. Have you had a bone marrow biopsy yet?
5. Given your original free light chain results from January and the fact that you are anemic and have a compression fracture, I would get to a hematologist that specializes in multiple myeloma ASAP. If you let us know what city your are in, folks on this forum might be able to recommend some myeloma treatment centers in your area.
Welcome to the forum. A few things:
1. You didn't include the units of measure and the normal ranges on your March test results Are you sure you are comparing the same type of light chain tests? There are serum FREE light chain tests and serum TOTAL light chain tests, and these are very different tests that have different normal ranges. But if the tests are indeed both serum free light chain tests, it's not that uncommon for there to be a lab error on these kinds of tests. You therefore might want to get re-tested.
3. Do you know what your M-spike is from your serum protein electrophoresis (SPEP) test is, what your IgG, IgA and IgM levels are, and what the results of your serum immunofixation test are?
4. You say you are anemic. Just how low is your hemoglobin level?
5. Have you had a bone marrow biopsy yet?
5. Given your original free light chain results from January and the fact that you are anemic and have a compression fracture, I would get to a hematologist that specializes in multiple myeloma ASAP. If you let us know what city your are in, folks on this forum might be able to recommend some myeloma treatment centers in your area.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Drop in kappa-lambda ratio with no treatment?
Sorry, I shouldn't have posted that just yet. I plan on adding all my test results today. Just so worried about this. I haven't even told my husband. Don't want him to worry needlessly.
Thanks.
Thanks.
-
MonaLL - Name: MonaLL
- Who do you know with myeloma?: No one
- Age at diagnosis: 61
Re: Drop in kappa-lambda ratio with no treatment?
Hi,
As I mentioned earlier, I have severe osteoporosis and I have a compression fracture, which so far not responding to any medications, I have very low ferritin (anemia) which isn't responding to the iron pills I am taking, also I am hypothyroid.
I went to my doctor to find out why I am so tired and she said I have low WBC, low ferritin, and high protein in my blood, so she sent me to a hematologist / oncologist. In her tests shows differently the his test. here is what shows on my tests, Two different results on kappa/lambda results and not sure which to believe. They used two different labs so I don't know which to believe.
Here is my doctors report:
Name of this report: immunofixation, urine
B12 - 357 (200-1100)
Urine Immunofix See note: Note: A weak restriction pattern is present, possibly representing artifact. A follow-up in 1 - 2 months is suggested.
Immunofix serum See note
Note: Normal pattern. No monoclonal proteins detected by immunofixation.
Vitamin B1 thia - 119 (78-185 nmo/l)
Ur free kap ltc 182.00 H (1.35-24.19 mg/l)
Ur free lam ltc 10.30 H (0.24-6.66)
Free kappa/lamda 17.67 H (2.04-10.37)
Here is the hematologist/oncologist reports:
Name of test: Immunofixation serum
Protein electro 5.7 l (6.2-8.0)gmldl
Albumin 3.0 l(3.5-4.7)gm/dl
Alpha-1-glob 0.2 (0.1-0.3)gm/dl
Alpha-2-glob 0.7 (0.5-1.0)gm/dl
Beta globulin 0.9 (0.8-1.4)gm/dl
Gamma globlin 0.9(0.6-1.6)gm/dl
P E Interpretation Note: decrease albumin and total protein compatible with malnutrition, malabsorption, chronic desease, and protein-losing conditions of various organs and systems.
Immunofix serum See note
Note: A weak restriction pattern is present, favored to present artifact. A follow up sample in 3 - 4 months is suggested. (which this is a follow up almost 2 months later)
Test name is: Free kappa/lambda lc/ ratio
Free kappa ltc 23.1 H (3.3-19.4) mg/dl
Free lambda ltc 14.6 (5.7-26.3) mg.dl
Fre kap/lam rat 1.58
Test name: Anti-nuclear antibody
RA quantitive <10 (<14) iu/ml
ANA positive H (negative)
ANA titter 1:320 H (<1:40) titer
ANA pattern, ref speckled H
Test name: Comprehensive metabolic panel
Glucose 90 (65-99) mg/dl
BUN 17 (7-25) mg/dl
Creatinine 0.8 (0.7-1.2) mg/dl
BUN/creat 21.3 (7.0-25.0)
Calcuim 8.3 L (8.5-10.4) mg/dl
LDH 181 (110-250) u/l
SGPT(ALT) 18 (2-40) u/l
SGOT (AST) 26 (4-35) u/l
Total protein 6.0 L (6.2-8.0) gm/dl
Albumin 3.5 L (3.6-5.0) gm/dl
Globulin 2.5 (2.1-3.5) gm/dl
Alkaline phos. 62 (31-125) u/l
Total bilirubin 0.4 (0.2-1.3) mg/dl
A/G ratio 1.4 (1.1-2.2)
Sodium 140 (135-145) mmol/l
Potassium 4.1 (3.5-5.2) mmol/l
Chloride 109 (97-109) mmol/l
CO2 26 (21-31) mmol/legfr >60
B12 410 (200-1100) pg/ml
Folate 24.0 >3.3 ng/ml
Anti-thyr perox 29 < 35 IU/ml
Anti throglob <2 <20 IU/ml
IgM serum 129 (48-271) mg/dl
IgA, serum 894 (694-1610) mg/dl
Test name: Protein electrophoresis, urine
Protein total u 28.0
Albumin urine 16.47 (0.00-100.0)%
Alpha-1-globulin 4.39 H (0.00)
Alpha-2-globulin 17.71 H (0.00)
Beta globulin 32.98 H (0.00)
Gamma globulin 28.45 H (0.00)
A/G ratio 0.2
Interpretation: Urine electrophoresis shows a pattern of non-selective glomerular proteinuria. No abnormal protein bands seen.
As I mentioned earlier, I have severe osteoporosis and I have a compression fracture, which so far not responding to any medications, I have very low ferritin (anemia) which isn't responding to the iron pills I am taking, also I am hypothyroid.
I went to my doctor to find out why I am so tired and she said I have low WBC, low ferritin, and high protein in my blood, so she sent me to a hematologist / oncologist. In her tests shows differently the his test. here is what shows on my tests, Two different results on kappa/lambda results and not sure which to believe. They used two different labs so I don't know which to believe.
Here is my doctors report:
Name of this report: immunofixation, urine
B12 - 357 (200-1100)
Urine Immunofix See note: Note: A weak restriction pattern is present, possibly representing artifact. A follow-up in 1 - 2 months is suggested.
Immunofix serum See note
Note: Normal pattern. No monoclonal proteins detected by immunofixation.
Vitamin B1 thia - 119 (78-185 nmo/l)
Ur free kap ltc 182.00 H (1.35-24.19 mg/l)
Ur free lam ltc 10.30 H (0.24-6.66)
Free kappa/lamda 17.67 H (2.04-10.37)
Here is the hematologist/oncologist reports:
Name of test: Immunofixation serum
Protein electro 5.7 l (6.2-8.0)gmldl
Albumin 3.0 l(3.5-4.7)gm/dl
Alpha-1-glob 0.2 (0.1-0.3)gm/dl
Alpha-2-glob 0.7 (0.5-1.0)gm/dl
Beta globulin 0.9 (0.8-1.4)gm/dl
Gamma globlin 0.9(0.6-1.6)gm/dl
P E Interpretation Note: decrease albumin and total protein compatible with malnutrition, malabsorption, chronic desease, and protein-losing conditions of various organs and systems.
Immunofix serum See note
Note: A weak restriction pattern is present, favored to present artifact. A follow up sample in 3 - 4 months is suggested. (which this is a follow up almost 2 months later)
Test name is: Free kappa/lambda lc/ ratio
Free kappa ltc 23.1 H (3.3-19.4) mg/dl
Free lambda ltc 14.6 (5.7-26.3) mg.dl
Fre kap/lam rat 1.58
Test name: Anti-nuclear antibody
RA quantitive <10 (<14) iu/ml
ANA positive H (negative)
ANA titter 1:320 H (<1:40) titer
ANA pattern, ref speckled H
Test name: Comprehensive metabolic panel
Glucose 90 (65-99) mg/dl
BUN 17 (7-25) mg/dl
Creatinine 0.8 (0.7-1.2) mg/dl
BUN/creat 21.3 (7.0-25.0)
Calcuim 8.3 L (8.5-10.4) mg/dl
LDH 181 (110-250) u/l
SGPT(ALT) 18 (2-40) u/l
SGOT (AST) 26 (4-35) u/l
Total protein 6.0 L (6.2-8.0) gm/dl
Albumin 3.5 L (3.6-5.0) gm/dl
Globulin 2.5 (2.1-3.5) gm/dl
Alkaline phos. 62 (31-125) u/l
Total bilirubin 0.4 (0.2-1.3) mg/dl
A/G ratio 1.4 (1.1-2.2)
Sodium 140 (135-145) mmol/l
Potassium 4.1 (3.5-5.2) mmol/l
Chloride 109 (97-109) mmol/l
CO2 26 (21-31) mmol/legfr >60
B12 410 (200-1100) pg/ml
Folate 24.0 >3.3 ng/ml
Anti-thyr perox 29 < 35 IU/ml
Anti throglob <2 <20 IU/ml
IgM serum 129 (48-271) mg/dl
IgA, serum 894 (694-1610) mg/dl
Test name: Protein electrophoresis, urine
Protein total u 28.0
Albumin urine 16.47 (0.00-100.0)%
Alpha-1-globulin 4.39 H (0.00)
Alpha-2-globulin 17.71 H (0.00)
Beta globulin 32.98 H (0.00)
Gamma globulin 28.45 H (0.00)
A/G ratio 0.2
Interpretation: Urine electrophoresis shows a pattern of non-selective glomerular proteinuria. No abnormal protein bands seen.
-
MonaLL - Name: MonaLL
- Who do you know with myeloma?: No one
- Age at diagnosis: 61
Re: Drop in kappa-lambda ratio with no treatment?
Ah, I see your confusion. With respect to free light chain test results, you are not comparing apples to apples. One set of numbers is from a serum free light chain assay. The other is from a urine free light chain assay. You should use the serum free light chain assay results (the one that has the ratio results of 1.58) as the measure of your free light chains. See https://myelomabeacon.org/forum/free-light-chain-flc-results-serum-urine-t2776.html#p15166
Did they only measure your IgA and IgM levels and not your IgG level?
Also, your urine test results look like those from a "spot" urine test (where you just provide a quick urine sample at the lab)? Or did you instead collect your urine over 24 hours before the test? You really want a 24 hour urine test to screen for something like myeloma.
I'm not a doctor and only a doctor should interpret your test results. But the test results you've posted don't seem to suggest myeloma. You have low serum protein levels, low calcium, normal creatinine, both your serum and urine immunofixation don't mention any abnormal protein bands and your serum electrophoresis didn't measure any abnormal protein. Your serum free light chain assay results are also "almost" normal (just a slightly elevated kappa level). You'd typically expect the opposite in one or more of the aforementioned test results if you had myeloma. The only exception to this would be if you had "nonsecretory" myeloma (which happens in less than 5% of myeloma patients). This is where the myeloma disease doesn't show up in urine and blood tests and can only be registered via a bone marrow biopsy.
Your liver (ALT, AST) and kidney functions (creatinine, BUN, etc) also seem normal. I honestly don't know what to say, but it does make sense to follow through with a good hematologist.
Did they only measure your IgA and IgM levels and not your IgG level?
Also, your urine test results look like those from a "spot" urine test (where you just provide a quick urine sample at the lab)? Or did you instead collect your urine over 24 hours before the test? You really want a 24 hour urine test to screen for something like myeloma.
I'm not a doctor and only a doctor should interpret your test results. But the test results you've posted don't seem to suggest myeloma. You have low serum protein levels, low calcium, normal creatinine, both your serum and urine immunofixation don't mention any abnormal protein bands and your serum electrophoresis didn't measure any abnormal protein. Your serum free light chain assay results are also "almost" normal (just a slightly elevated kappa level). You'd typically expect the opposite in one or more of the aforementioned test results if you had myeloma. The only exception to this would be if you had "nonsecretory" myeloma (which happens in less than 5% of myeloma patients). This is where the myeloma disease doesn't show up in urine and blood tests and can only be registered via a bone marrow biopsy.
Your liver (ALT, AST) and kidney functions (creatinine, BUN, etc) also seem normal. I honestly don't know what to say, but it does make sense to follow through with a good hematologist.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Drop in kappa-lambda ratio with no treatment?
Hey Multibilly, thanks for responding,
So kappa/lambda isn't important in urine? Just curious.
So kappa/lambda isn't important in urine? Just curious.
-
MonaLL - Name: MonaLL
- Who do you know with myeloma?: No one
- Age at diagnosis: 61
Re: Drop in kappa-lambda ratio with no treatment?
Before commenting on urine free light chain ratios, it would be helpful if you first answered some of my above questions: What is your hemoglobin (Hgb) level (with units of measure and normal reference range)? Did you have a spot urine test or a 24-hour urine test, did they measure your IgG level? Have you had a bone marrow biopsy yet? Etc
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Drop in kappa-lambda ratio with no treatment?
Hi Multibilly,
Thanks for your response. Sorry I missed this other report. On it it says my
Test Name: CBC/Auto Diff:
I list the tests that came up abnormal.
WBC - 3.2 L (3.8-10.8) TH/UL My doctor can't find why this is always so low. Actually I notice that 3.2 is rather high right now for me.
Hemoglobin- 13.0 (12.0-16.0) g/dl
Plt - 15.1 H (11.5-15.0) %
Mono - 12.0 H (0.10)%
RBC Morph - Abnormal (normal)
Antisocytosis - Slight H
The numbers in parentheses are the normal ranges.
I did have a 24 hour urine testing for both doctors. I haven't had a bone biopsy.
IgM - 129 (98-271) mg/dL
IgG - 894 (694-1618) mg/dL
IgA - 81 (81-463) mg/dL
Ferritin - 7 L (20-288) ng/ml
Cannot bring that number above 10. Doctor frustrated.
Frustrated here. I do have a hematologist/oncologist appointment on April 6.
I know your not a doctor but it is nice to get your opinion. Thank you so much.
Thanks for your response. Sorry I missed this other report. On it it says my
Test Name: CBC/Auto Diff:
I list the tests that came up abnormal.
WBC - 3.2 L (3.8-10.8) TH/UL My doctor can't find why this is always so low. Actually I notice that 3.2 is rather high right now for me.
Hemoglobin- 13.0 (12.0-16.0) g/dl
Plt - 15.1 H (11.5-15.0) %
Mono - 12.0 H (0.10)%
RBC Morph - Abnormal (normal)
Antisocytosis - Slight H
The numbers in parentheses are the normal ranges.
I did have a 24 hour urine testing for both doctors. I haven't had a bone biopsy.
IgM - 129 (98-271) mg/dL
IgG - 894 (694-1618) mg/dL
IgA - 81 (81-463) mg/dL
Ferritin - 7 L (20-288) ng/ml
Cannot bring that number above 10. Doctor frustrated.
Frustrated here. I do have a hematologist/oncologist appointment on April 6.
I know your not a doctor but it is nice to get your opinion. Thank you so much.
-
MonaLL - Name: MonaLL
- Who do you know with myeloma?: No one
- Age at diagnosis: 61
Re: Drop in kappa-lambda ratio with no treatment?
OK, thanks.
Regarding the urine free light chain ratio, again look at Dr. Libby's comments regarding urine free light chain measurements.
Also, see Dr. Hoffman's comments here:
https://myelomabeacon.org/forum/kappa-lambda-ratio-blood-urine-t6120.html#p37400
Regarding the urine free light chain ratio, again look at Dr. Libby's comments regarding urine free light chain measurements.
Also, see Dr. Hoffman's comments here:
https://myelomabeacon.org/forum/kappa-lambda-ratio-blood-urine-t6120.html#p37400
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
9 posts
• Page 1 of 1
Return to Do I Have Multiple Myeloma?