[Pelzl]

Electrophoresis/immunofixation/waldenstroem/myeloma

by Pelzl on Sat Mar 23, 2013 11:01 am

Hey

I am a 26year old female and severly chronically ill.

Since 2 Years I have been suffering from immunological Problems, thereunder a painful neuropathy.

The last blood test showed elevated total protein, deranged blood coagulation (decreased quick/ elevated INR, decreased fibrinogen), leukopenia with relative lymphocytosis and high basophils, mild anemia, and findings consistent with the clinical picture of skin vasculitis. Cryoglobulins were ordered but could not be done due to difficulty to get enough blood: despite adequate hydration, the blood oftten just stopped in the canule and could not be drawn.

Clinically, I have been suffering from skin changes and vasculitis on the legs/feet ss well as intermittent / recurrent gastrointestinal bleeding, tendency to form small blood clots.

A skin biopsy showed IgM deposits. The skin changes and vasculitis have not responded to systemic corticosteroids.

An electrophoresis done 8 months ago showed no M Protein, despite elevtd total protein (in the absence of dehydration), but no Immunfixation was done and the dlinical picture was not as severe as now back then.

Now, immunoglobulin levels were measured which were normal but the distribution was odd: IgA and IgG at the lowest end of normal, IgM at the upper end. IgG sublclasses showed high IgG4 and decreased IgG3.

However, this study was done only two weeks after corticosteroid treatment (which was high dose and lasted 4weeks) - could this affect immunoglobulin level, electrophoresis result, the detection of an M Protein etc? Theoretically - could high dose dexamethasone cause a complete remission of M protein in the blood whereas the paraprotein deposits in tissue remain?

2 years ago, when problems began to evolve, a slightly elevated IgM was measured.

1 year ago a lymphoproliferative disease such as Castleman was suspected because of the eneuropathy and a thymic mass, along with mutiple lymph node enlargements in the mediastinum. I finally had surgery to remove the thymic mass, and it was consistent with thymic B Cell hyperplasia, but I do Not have myasthenia.

Now, because of the IgM desposits, vasculitis etc this possibility seems to be renewed as all I can find reagrding these issues seems to point to a lymphoproliferative disease, especially waldenstroem or related diseases.

But I would like to ask if I should visit an hematologist to discuss my case, if wqldenstroem /myeloma etc is a possibility at all... What do you think?

Thanks...

P.s.: I also have a condition called erythromelalgia which may prcede hematological diseases.

[Dr. Jason Valent]

Re: Electrophoresis/immunofixation/waldenstroem/myeloma

by Dr. Jason Valent on Mon Mar 25, 2013 4:44 pm

Yes, an evaluation by hematology would be appropriate.

[pelzl]

Re: Electrophoresis/immunofixation/waldenstroem/myeloma

by pelzl on Mon Apr 01, 2013 7:49 pm

Thank you very much Dr. Valent..

- Which tests should one get for general evaluation for myeloma, waldenstrom etc?

- Could a possible cryoglobulinemia cause IgM deposits in the skin/vasculitis/neuropathy and may this be a sign myeloma or waldenstrom? in other words: may cryoglobulinemia wirh vasculitis and neuropathy be a (first) presentation of myeloma, waldenstrom?

- Are there any other lymphoproliferative diseases which could cause a similar clinical picture?

- I have noticed that my urine smells very odd, I'd say "chemical" (no bacteria or normal protein/glucose were found). I hjave read that light chains may be excreted with the urine...
does this light chain protein make urine smell?

- Can the abnormal cryoglobulin cause elevated total protein? Would this cryoglobulin show up in the electrophoresis?

Thank you very much!