[Nicc143]

Elevated kappa & K-L ratio with M-spike

by Nicc143 on Wed Aug 23, 2017 11:41 am

Hi,

I am new to this site, and am looking for information or well to see if I should ask further questions with my grandfather's health.

My grandfather is 83 years old and hasn't been feeling himself for the past month. He is having dizzy spells and very unbalanced to the point he can't stand nor walk without assistance. He is currently staying with me. His doctor ordered bloodwork and an MRI for his brain. The MRI results came back no signs of a new stroke. And his bloodwork according to the doctor was not alarming. I know I am not a doctor but I did look up his bloodwork and their were a few things that caught my attention. (I have listed his bloodwork below for reference).

After looking more into kappa and lambda ratio it pointed me to possible multiple myeloma or smoldering multiple myeloma. I believe.

I guess my question is: Is this normal for the numbers to be this high without any concerns from his physician? Also, to add, my grandfather was already diagnosed with stage 3 kidney disease a few years ago.

Any information or advice will be greatly appreciated!

- Nicole

Component Your Value Standard Range Flag
KAPPA QT 85.71 mg/L 3.30-19.40 mg/L H
LAMBDA QT 17.04 mg/L 5.71-26.30 mg/L
K-L RATIO 5.03 0.26-1.65 H

IgG 1392 mg/dL 700-1600 mg/dL
IgA 96 mg/dL 70-400 mg/dL
IgM 69 mg/dL 40-230 mg/dL

WBC 6.88 K/uL 4.00-10.80 K/uL
RBC 4.05 M/uL 4.50-5.25 M/uL L
HGB 13.0 g/dL 14.0-16.8 g/dL L
HCT 39.5 % 40.0-48.4 % L
MCV 97.5 fL 82.0-99.5 fL
MCH 32.1 pg 27.0-34.0 pg
MCHC 32.9 g/dL 32.0-36.0 g/dL
RDW 16.0 % 11.5-15.5 % H
PLTLT CT 212 K/uL 140-400 K/uL

BUN 28 mg/dL 6-20 mg/dL H
Creatinine 1.6 mg/dL 0.7-1.3 mg/dL H
Sodium 139 mmol/L 135-146 mmol/L
Potassium 3.8 mmol/L 3.5-5.1 mmol/L
Chloride 102 mmol/L 98-107 mmol/L
CO2 26 mmol/L 22-32 mmol/L
Anion Gap 11 mmol/L 7-15 mmol/L
Glucose 99 mg/dL 70-120 mg/dL
Albumin 4.8 g/dL 3.8-5.0 g/dL
AST 19 U/L 10-50 U/L
ALK Phos 53 U/L 0-153 U/L
Bili, Tot 1.1 mg/dL 0-1.2 mg/dL
Calcium 10.1 mg/dL 8.1-10.2 mg/dL
Protein 8.4 g/dL 6.0-8.3 g/dL H
ALT 12 U/L 10-50 U/L
E Glom
Filt Rate 40.5 >60 L

Serum Prot 7.8 g/dL 6.0-8.3 g/dL
Albumin 3.85 g/dL 3.3-4.4 g/dL
Alpha 1 0.31 g/dL 0.1-0.3 g/dL H
Alpha 2 1.16 g/dL 0.6-1.0 g/dL H
Beta 0.96 g/dL 0.8-1.3 g/dL
Gamma 1.51 g/dL 0.7-1.7 g/dL
M-spike 0.96 g/dL g/dL

EPGS Interp
A paraprotein is present. Appropriate studies, including quantitative immunoglobulins and immunofixation electrophoresis have been ordered in follow-up.

See immunofixation electrophoresis report.
A Bence Jones protein evaluation is recommended in follow-up, if clinically necessary.

A monoclonal IgG kappa gammopathy is present.

[Multibilly]

Re: Elevated kappa & K-L ratio with M-spike

by Multibilly on Wed Aug 23, 2017 1:34 pm

Hi Nicc143,

Welcome to the forum.

Keeping in mind that I'm not a doctor, this seems likely to be a case of MGUS. MGUS is actually fairly common in elderly folks and many folks go through life without ever knowing they have it and are usually none the worse for it. In general, one does not treat MGUS, but rather simply monitors it to see if it ever evolves into smoldering myeloma or symptomatic multiple myelma.

Given that your grandfather seems to be a bit anemic (which can be a result of MGUS or perhaps one of his other comorbidities) and that he obviously has an IgG kappa gammopathy (probably MGUS), it may be prudent for him to follow up with a hematologist for an official diagnosis. The hematologist may very well suggest having your grandfather's physician simply perform these same routine blood labs every few months to a year to make sure that the MGUS isn't turning into something more serious. In general, the risk of MGUS progressing to symptomatic multiple myeloma is on the order of 2 percent per year.