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Elevated both calcium & alkaline phosphatase
Hello, I have mgus. (IgG lambda) I am back from a new hem doctor. Have not been feeling well. Here's what has changed in my labs. For the first time since mgus diagnoses, Elevated calcium and my total protein is now elevated. My white cells have been high since day one of mgus, but higher now. (Absolute Neutrophils). My GRF is decreased now. Albumin is 5.0 now, glucose up too. The doctor did say he concerned things might be changing, but need another BMB and also want to test for amyloidosis. What is your thoughts on my labs? Would that suggest mgus progressing to multiple myeloma? The doctor suggested me to take zometa. They are seeing if my insurance will approve it. Any other thoughts?
Re: Elevated both calcium & alkaline phosphatase
Dear bad blood,
I agree with your doctor that a repeat, thorough evaluation of your MGUS is warranted to determine if it has evolved into symptomatic multiple myeloma and/or amyloidosis. Alkaline phosphatase is an enzyme that is produced in liver and bone. As such, an elevated alkaline phosphatase can be a reflection of bone lesions from myeloma (although in the majority of cases, myeloma bone problems do NOT cause an elevated alkaline phosphatase). A high calcium level is a more common manifestation of bone problems related to myeloma. However, recognize that other things can cause an elevated calcium level as well (e.g. the diuretic hydrochlorothiazide, an overactive parathyroid gland).
An elevated alkaline phosphatase can also be a function of liver injury from many causes -- amyloidosis would be one of them.
The albumin and glucose are less concerning from the perspective of amyloid and myeloma. Amyloid would more likely be associated with a low albumin and blood sugar should not be affected directly by either.
I agree with a bone marrow biopsy and screen for amyloidosis. I would also do a skeletal survey at the least and possibly additional imaging (MRI). I would look at other causes of a high calcium level. Whether or not you should go on zometa depends on the results of the above testing.
Good luck!
Pete V.
I agree with your doctor that a repeat, thorough evaluation of your MGUS is warranted to determine if it has evolved into symptomatic multiple myeloma and/or amyloidosis. Alkaline phosphatase is an enzyme that is produced in liver and bone. As such, an elevated alkaline phosphatase can be a reflection of bone lesions from myeloma (although in the majority of cases, myeloma bone problems do NOT cause an elevated alkaline phosphatase). A high calcium level is a more common manifestation of bone problems related to myeloma. However, recognize that other things can cause an elevated calcium level as well (e.g. the diuretic hydrochlorothiazide, an overactive parathyroid gland).
An elevated alkaline phosphatase can also be a function of liver injury from many causes -- amyloidosis would be one of them.
The albumin and glucose are less concerning from the perspective of amyloid and myeloma. Amyloid would more likely be associated with a low albumin and blood sugar should not be affected directly by either.
I agree with a bone marrow biopsy and screen for amyloidosis. I would also do a skeletal survey at the least and possibly additional imaging (MRI). I would look at other causes of a high calcium level. Whether or not you should go on zometa depends on the results of the above testing.
Good luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Elevated both calcium & alkaline phosphatase
Thank you Sir,
I was told to have parathyroid test.
I was told to have parathyroid test.
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