[Songbird]

Faint IgG kappa & leukopenia, but doctor not concerned?

by Songbird on Thu Jan 19, 2017 11:31 pm

Hello to all!

This is my first time posting. I have been worrying for weeks now and I am afraid I am being pushed off. I am hoping I can get some insight into others and maybe guidance of why my doctor isn't acting more concerned.

I am a 29-year-old single mom of three. On September 26, 2016 I had a full hysterectomy for endometriosis, but it was a last resort because they couldn't figure out why I was bleeding, it onset immediate menopause. I lost control of what my body is suppose to feel like – what was normal and what was menopause.

I dealt fine, nothing extreme until I started getting sick with constant nausea, which landed me in the emergency room because I started vomiting blood. I followed up with a fill in for my regular doctor who thought I had the flu and nothing to worry about. He ran a CBC, which showed a 3.1 WBC. When I saw these results, I realized that my WBC had been low for the last 8 years. I made a quick call to my doc and asked if I should be concerned; he referred me to a hematologist.

The hematologist said it could mean a slew of things and ordered a boatload of tests after admitting that I had minor body aches, which I thought were part of menopause. These are some of the results (only posting what I feel might give an insight of what you need to advise, please let me know if there is another test you need to see the results of)

Component Value Std Range
WBC 3.5 K/uL 4.5 - 11.0 K/uL
RBC 4.14 M/uL 4.20 - 5.40 M/uL
HEMOGLOBIN 12.1 g/dL 12.0 - 16.0 g/dL
HEMATOCRIT 35.7 % 36.0 - 46.0 %
MCV 86.2 fL 82.0 - 100.0 fL
MCH 29.2 pg 27.0 - 34.0 pg
MCHC 33.9 g/dL 31.0 - 37.0 g/dL
RDW 12.2 % 11.0 - 14.5 %
RDW-STDEV 37.2 fL 37.0 - 54.0 fL
PLATELETS 178 K/uL 140 - 440 K/uL
MPV 12.0 fL 8.9 - 12.8 fL
NEUTROPHILS 46 % 42 - 75 %
LYMPHOCYTES 42 % 24 - 44 %
MONOCYTES 9 % 2 - 10 %
EOSINOPHILS 2 % 0 - 7 %
BASOPHILS 1 % 0 - 1 %
NEUTROPH ABS 1.61 K/uL 1.40 - 6.50 K/uL
LYMPHOCY ABS 1.47 K/uL 1.20 - 4.00 K/uL
MONOCY ABS 0.32 K/uL 0.10 - 0.60 K/uL
EOSINO ABS 0.08 K/uL 0.00 - 0.70 K/uL
BASOPHL ABS 0.02 K/uL 0.00 - 0.20 K/uL

Component Value Std Range
SODIUM 141 mmol/L 136 - 145 mmol/L
POTASSIUM 3.7 mmol/L 3.5 - 5.1 mmol/L
CHLORIDE 101 mmol/L 98 - 107 mmol/L
CO2 26 mmol/L 22 - 29 mmol/L
CALCIUM 9.5 mg/dL 8.6 - 10.0 mg/dL
BUN 11 mg/dL 6 - 20 mg/dL
CREATININE 0.66 mg/dL 0.51 - 0.95 mg/dL
GLUCOSE 88 mg/dL 74 - 106 mg/dL
TOT PROTEIN 8.0 g/dL 6.4 - 8.3 g/dL
ALBUMIN 4.3 g/dL 3.5 - 5.2 g/dL
BILIRUB TOT 0.5 mg/dL 0.2 - 1.0 mg/dL
ALK PHOSPH 60 U/L 35 - 104 U/L
AST 18 U/L <=33 U/L
ALT 15 U/L <=33 U/L

GFR >60 mL/min/1.73 sq meter
GFR std rng: >=60 mL/min/1.73 sq meter

LACTATE DEHY 127 U/L 135 - 225 U/L

Component Value Std Range

TOTAL PROTEIN 7.9 g/dL 6.4 - 8.2 g/dL
ALBUMIN SPE 4.61 g/dL 3.50 - 5.30 g/dL
ALPHA 1 GLOBULIN SPE 0.23 g/dL 0.11 - 0.31 g/dL
ALPHA 2 GLOBULIN SPE 0.77 g/dL 0.58 - 1.16 g/dL
BETA GLOBULIN 0.90 g/dL 0.59 - 0.88 g/dL
GAMMA GLOBULIN 1.38 g/dL 0.50 - 1.35 g/dL

Very faint equivocal band identified in gamma region. Recommend repeat electrophoresis in 3-6 months or serum free light chains to evaluate the significance of this finding.

Clinical Information: 29 year old female with leukopenia

Smear Review: Normocytic, normochromic anemia. White cells and platelets are morphologically unremarkable. No blasts identified.

ESR (SEDIMENTATION RATE) - 37 millimeter/hr (0 - 20 millimeter/hr)

IMMUNOFIXATION - Faint IgG kappa present.

I had a follow-up with the doctor who stated some of my tests were slightly elevated. He said it could be 3 paths (auto immune, multiple myeloma, lymphoma), I could wait and retest, but if I was going to worry the whole time, then we need to do the tests now. I chose to continue testing to get a result. I have had these tests come back.

Reason For Exam: Other decreased white blood cell (WBC) count, Other fatigue, multiple joint pain.

Findings: Spleen is normal size and homogeneous measuring 10 x 4.1 x 4.1 cm. Pancreas is not seen due to overlying bowel gas. IVC is phasic and the aorta tapers normally. Gallbladder is present and distended without evidence of intraluminal filling defects. Gallbladder wall
measures 0.2 cm and the common bile duct measures 0.4 cm. Liver is overall heterogeneous in appearance and this probably represents fatty infiltrate. 2 echogenic areas are seen within the liver, the largest measuring 0.6 cm with associated posterior acoustic shadowing and this
most likely represents calcification. There is no ascites. Right kidney measures 12 x 4 x 4.6 cm with the cortex measuring 1.2 cm. Left kidney measures 10.7 x 4.7 x 5.2 cm with the cortex measuring 1.4 cm. There is no ascites.

IMPRESSION:

1. Probable fatty infiltrate of the liver.
2. Normal-appearing gallbladder.

IgG 1370 mg/dL 700 - 1600 mg/dL
IgA 340 mg/dL 70 - 400 mg/dL
IgM 62 mg/dL 40 - 230 mg/dL

KAPPA FREE LIGHT CHAIN 3.43 mg/dL 0.3300 - 1.94 mg/dL
LAMBDA FREE LIGHT CHAIN 2.15 mg/dL 0.5700 - 2.63 mg/dL
KAPPA/LAMBDA RATIO 1.60 0.2600 - 1.65

Component Value Std Range
WBC 3.6 K/uL 4.5 - 11.0 K/uL
RBC 4.08 M/uL 4.20 - 5.40 M/uL
HEMOGLOBIN 11.9 g/dL 12.0 - 16.0 g/dL
HEMATOCRIT 35.7 % 36.0 - 46.0 %
MCV 87.5 fL 82.0 - 100.0 fL
MCH 29.2 pg 27.0 - 34.0 pg
MCHC 33.3 g/dL 31.0 - 37.0 g/dL
RDW 12.6 % 11.0 - 14.5 %
RDW-STDEV 39.2 fL 37.0 - 54.0 fL
PLATELETS 150 K/uL 140 - 440 K/uL
MPV 11.7 fL 8.9 - 12.8 fL
NEUTROPHILS 47 % 42 - 75 %
LYMPHOCYTES 41 % 24 - 44 %
MONOCYTES 10 % 2 - 10 %
EOSINOPHILS 3 % 0 - 7 %
BASOPHILS 0 % 0 - 1 %
NEUTROPH ABS 1.66 K/uL 1.40 - 6.50 K/uL
LYMPHOCY ABS 1.45 K/uL 1.20 - 4.00 K/uL
MONOCYTE ABS 0.35 K/uL 0.10 - 0.60 K/uL
EOSINOPH ABS 0.09 K/uL 0.00 - 0.70 K/uL
BASOPH ABS 0.01 K/uL 0.00 - 0.20 K/uL

Component Value Std Range
RETICULOCYTES 0.8 % 0.9 - 2.2 %
IMMATURE RETIC
FRACTION 2.1 % 3.3 - 13.6 %
RETICULOCYTE,
ABSOLUTE 0.0300 10e6/uL 0.0160 - 0.0700 10e6/uL
RETICULOCYTE
HEMOGLOBIN CONTENT 33.6 pg 27.8 - 37.7 pg

Bone Marrow (SS17-539)

Analysis: CD45 vs. side scatter and CD71 vs CD45 gating shows the following differential: blasts 3%, granulocytes 73%, erythroids 6%, monocytes 4% and lymphocytes 13%. Monocytes show normal co-expression of CD11b and HLA-DR. 3% of cells coexpress CD13 and CD34.

The ratio of CD3+/CD19- T cells to CD19+/CD3- B cells is approximately 2 to 1. There is no aberrant CD5/CD19 coexpression. B cells express kappa and lambda light chains in a polyclonal pattern. There is no increase in the number of CD38, CD138 positive plasma cells, which are polyclonal by kappa and lambda light chains.

Interpretation: No clonal B-cell population. No clonal plasma cell population. No increase in blasts.

LENGTH OF COLLECTION 24 HR 24 - 24 HR
VOLUME, 24 HR URINE 1000 mL mL
PROTEIN CONCENTRATION 8 mg/dL 0 - 12 mg/dL
PROTEIN TOTAL, 24 HR UR 80 mg/24 hrs 0 - 165 mg/24 hrs
CREATININE, URINE 85.2 mg/dL 29.0 - 226.0 mg/dL
Reference Range varies with fluid intake and diet.
CREATININE, 24 HR URINE 0.9 g/24 hrs 0.7 - 1.5 g/24 hrs
24 HR UPE INTERP See Interpretation Below

CREATININE 0.74 mg/dL 0.51 - 0.95 mg/dL

Reason For Exam: Other decreased white blood cell (WBC) count, monoclonal gammopathy.

Findings: CT of the abdomen and pelvis was performed utilizing oral and intravenous contrast. 100 mL's of Optiray 320 was utilized for vessel opacification. There are no previous scans for comparison purposes. There is probable mild fatty infiltrate of the liver but the liver is otherwise smooth and homogeneous. Ductal dilatation or ascites is not evident. Pancreas appears to be normal. Gallbladder is present. Spleen appears to be generous but homogeneous. Right and left adrenal glands are unremarkable. Kidneys are functionally and anatomically intact. Periaortic or pericaval adenopathy is not evident and there is no evidence of aneurysm formation. Iliac nodal chain is normal. Umbilical hernia is not apparent. There is no abdominal or pelvic ascites. Diverticulitis is not apparent. Bone windows appear to be unremarkable.

IMPRESSION:

1. Mild splenic prominence.
2. Probable minimal fatty infiltrate of the liver.

So I know this is a ton of information to throw out there, but I had emailed my doctor about the pain I am feeling in my arms, legs and hips (I had thought it was a part of menopause originally). It is progressively getting worse to include the inability to sleep, constant ibuprofen. I asked if I should make an appointment with my primary or if it's a part of what my test results are displaying. He replied that the symptoms are not in line with what I am being tested for especially for the "encouraging preliminary results."

I am extremely confused and concerned that I might not be getting taken seriously because I don't fall in line with the statistics of my age and the potential damage to my liver and spleen. It's getting more and more painful to move my arms and I am overall not feeling good. I am still waiting for my bone marrow biopsy to come back, and I may be over analyzing, but to be honest, I am tired, achy and scared.

Maybe I am missing a clue somewhere? Is there a possibility that the kappa may be representing another problem? Is it okay to show these abnormal proteins and it not show on the flow cytometry?

Again I truly appreciate anyone's input!

[Multibilly]

Re: Faint IgG kappa & leukopenia, but doctor not concerned?

by Multibilly on Fri Jan 20, 2017 8:58 am

Hi Songbird,

Welcome to the forum.

I'm only going to reply in the context of a plasma cell disorder such as MGUS or myeloma. Your IgG, IgA and IgM levels are all normal. No abnormal protein was measured on your serum protein electrophoresis. Your serum free light chains are all in the normal range. Your bone marrow biopsy confirmed that all of your B-cells and plasma cells are polyclonal (normal) and aren't showing any increased CD38 or CD138 expression (also good). Your 24 hour urine test made no mention of finding any m-protein (Bence Jones proteins), assuming they did an electrophoresis test on the urine.

Yes, you do have a faint IgG-kappa band, but this could very well be transient and may disappear the next time you get tested (I recommend you do get another serum electrophoresis, immunofixation and free light chain assay in a few months just to put that issue to rest). I'm not a doc, but it doesn't seem like you have a monoclonal gammopathy based on all the above findings.

If you are getting a second bone marrow biopsy, it may be good to ask that they run a Congo red stain test to rule out amyloidosis (although none of your urine and blood tests seem to suggest amyloidosis either).

If you think you aren't being taken seriously, I would suggest getting a second opinion at a top-notch facility. If you let us know what city you are in, folks may be able to recommend some facilities that have staffs of multiple specialists that may be able to sort out what's going on with you.

Good luck and let us know what happens.

[Songbird]

Re: Faint IgG kappa & leukopenia, but doctor not concerned?

by Songbird on Fri Jan 20, 2017 10:16 am

That is a breath of fresh air! My doctor said the bone marrow biopsy wasn't in yet, and there is another test that is called bone marrow cell count that says "no information at this time", and there is a test that wont display rich text not displayed. Is that the additional test you recommended?

[Multibilly]

Re: Faint IgG kappa & leukopenia, but doctor not concerned?

by Multibilly on Fri Jan 20, 2017 12:08 pm

Admittedly, I am a bit confused about your bone marrow biopsies. It looks like you posted the results of an earlier bone marrow biopsy test. Did you get a second biopsy or are you just waiting on additional results from that first biopsy?

If a monoclonal gammopathy is suspected, the pathologist will usually measure the percentage of cells that are plasma cells. This number should be under 5% in normal folks. I can't say if the other "rich text" test is a Congo red stain test or not. In addition to flow cytometry, there are several different tests that pathologists run on a bone marrow biopsy for suspected monoclonal gammopathy patients that include FISH, karyotyping, etc.

[Songbird]

Re: Faint IgG kappa & leukopenia, but doctor not concerned?

by Songbird on Fri Jan 20, 2017 2:12 pm

It was only one biopsy so I suspect the other tests showing on my labs is those tests you are referring to! There is lots of info that I couldn't find out like the 5%, great info.

I appreciate your help and will update at my next appointment!

[Hannahbower]

Re: Faint IgG kappa & leukopenia, but doctor not concerned?

by Hannahbower on Sun Aug 20, 2017 5:59 pm

Hi Songbird!

I know this post is a bit old, but I thought I'd check to see what you have found out. Our labs and biopsy look very similar, and my doctors are trying to figure out what's going on. Thanks in advance for any insight you can provide