Hi,
I am a 53 year old female being worked up for hypercalcemia. I received the following test results and I am a little concerned about the M-spike and lambda chain. Even though I am an RN with many years experience, it is in cardiology, not hematology. I appreciate any help.
IMMUNOFIXATION,SERUM (25700-6)
Detected; Reference Range: Not Detected; FINAL
A faint Free Lambda (monoclonal free light chain) band present.
ABNORMAL PROTEIN BAND 1 (51435-6)
0.15 H ; Reference Range: None Detected g/dL ; FINAL
INTERPRETATION (12851-2)
Evaluation reveals a faint restricted band (M-spike) migrating in the gamma globulin region. Please refer to immunofixation analysis or consider performing immunofixation analysis
Thanks,
Michelle
Forums
7 posts
• Page 1 of 1
Re: Faint lambda band & M-spike with hypercalcemia
Hi Michelle,
Welcome to the forum.
Given you have hypercalcemia and they detected monoclonal lambda free light chains, you should really get a serum free light chain assay to see what those values are. Note that the 0.15 g/dL abnormal protein 1 value is not measuring your monoclonal lambda free light chain value, but rather the monoclonal heavy chain component (aka "m-spike"). Keep in mind that the 0.15 g/dL m-spike is quite small (which is good news), but this doesn't necessarily mean that your monoclonal lambda free light chain value is small as well.
Also, note that myeloma doesn't always reflect its disease burden in one's blood or urine. You can have situations where the disease is primarily present in the bone marrow and the serum numbers will look fine or will only partially reflect the overall disease burden (yet you can still experience things like hypercalcemia, renal insufficiency, anemia, bone damage, etc). If your doctor suspects this kind of a situation and doesn't have another explanation for your hypercalcemia, he/she would likely order a bone marrow biopsy.
Lastly, how are your creatinine and hemoglobin levels doing?
Welcome to the forum.
Given you have hypercalcemia and they detected monoclonal lambda free light chains, you should really get a serum free light chain assay to see what those values are. Note that the 0.15 g/dL abnormal protein 1 value is not measuring your monoclonal lambda free light chain value, but rather the monoclonal heavy chain component (aka "m-spike"). Keep in mind that the 0.15 g/dL m-spike is quite small (which is good news), but this doesn't necessarily mean that your monoclonal lambda free light chain value is small as well.
Also, note that myeloma doesn't always reflect its disease burden in one's blood or urine. You can have situations where the disease is primarily present in the bone marrow and the serum numbers will look fine or will only partially reflect the overall disease burden (yet you can still experience things like hypercalcemia, renal insufficiency, anemia, bone damage, etc). If your doctor suspects this kind of a situation and doesn't have another explanation for your hypercalcemia, he/she would likely order a bone marrow biopsy.
Lastly, how are your creatinine and hemoglobin levels doing?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Faint lambda band & M-spike with hypercalcemia
Thanks for your help, Multbilly.
My creatinine is normal. Last CBC was fine. My parathyroid is high, vitamin D low, and I have osteopenia. My endocrinologist feels that parathyroid is the culprit for high calcium. She has referred me to a hematologist-oncologist for the blood results I referred to in last post. So there is no measurement for the lambda results, I assumed "faint" was a measurement.
I have an appointment the week after Thanksgiving to see a new doctor. What kind of blood tests should I get? I have no problem asking for something that he might not order.
Michelle
My creatinine is normal. Last CBC was fine. My parathyroid is high, vitamin D low, and I have osteopenia. My endocrinologist feels that parathyroid is the culprit for high calcium. She has referred me to a hematologist-oncologist for the blood results I referred to in last post. So there is no measurement for the lambda results, I assumed "faint" was a measurement.
I have an appointment the week after Thanksgiving to see a new doctor. What kind of blood tests should I get? I have no problem asking for something that he might not order.
Michelle
Re: Faint lambda band & M-spike with hypercalcemia
Hi Michelle,
So, be clear that the "faint" free lambda number you are referring to is part of the immunofixation test, which doesn't actually measure the amount of lambda free light chains in your system. All the immunofixation test does is present a series of "smudges" on a panel that indicates whether there might be some monoclonal proteins floating around in your system and what the nature of those monoclonal proteins are (e.g. kappa free light chain, etc).
If you want to continue to rule out myeloma, I would still suggest getting a serum free light chain assay, which would actually measure your lambda and kappa free light chain levels.
So, be clear that the "faint" free lambda number you are referring to is part of the immunofixation test, which doesn't actually measure the amount of lambda free light chains in your system. All the immunofixation test does is present a series of "smudges" on a panel that indicates whether there might be some monoclonal proteins floating around in your system and what the nature of those monoclonal proteins are (e.g. kappa free light chain, etc).
If you want to continue to rule out myeloma, I would still suggest getting a serum free light chain assay, which would actually measure your lambda and kappa free light chain levels.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Faint lambda band & M-spike with hypercalcemia
Multibilly,
Yes ruling out is exactly what I would like to do. I appreciate your quick and knowledgeable response and I will make sure that I get a serum free light chain assay when I see the hematologist-oncologist.
Thanks again,
Michelle
Yes ruling out is exactly what I would like to do. I appreciate your quick and knowledgeable response and I will make sure that I get a serum free light chain assay when I see the hematologist-oncologist.
Thanks again,
Michelle
Re: Faint lambda band & M-spike with hypercalcemia
Hi Michelle,
I'm sure you are anxious before your appointment. With the high PTH and calcium, is your endocrinologist suggesting you have parathyroid surgery? I had one of my parathyroids removed this past July due to high PTH and calcium. I had to have special CT of the neck prior to the surgery.
After that was completed, we discovered my monoclonal protein. My myeloma specialist was worried that the high calcium was myeloma related. However, 4 months after the surgery, my calcium is remaining normal and my PTH is back down. The primary parathyroidism left me with osteoporosis. It moved from osteopenia to osteoporosis in 2 years, so don't delay in further testing.
All the best,
Eileen
I'm sure you are anxious before your appointment. With the high PTH and calcium, is your endocrinologist suggesting you have parathyroid surgery? I had one of my parathyroids removed this past July due to high PTH and calcium. I had to have special CT of the neck prior to the surgery.
After that was completed, we discovered my monoclonal protein. My myeloma specialist was worried that the high calcium was myeloma related. However, 4 months after the surgery, my calcium is remaining normal and my PTH is back down. The primary parathyroidism left me with osteoporosis. It moved from osteopenia to osteoporosis in 2 years, so don't delay in further testing.
All the best,
Eileen
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Eileenk - Name: Eileen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Smoldering, September 2017
- Age at diagnosis: 49
Re: Faint lambda band & M-spike with hypercalcemia
Hi Eileenk,
We are not discussing surgery yet. I am on supplemental D and now starting calcium supplement.(seems counterintuitive). I also have to have a 24-hour urine, but based upon what I have read in this forum, it is possible that I will need that also from the hematologist-oncologist, so I am holding off a week in hopes that I only need to do it once.
Again, I am learning a lot reading through all the posts and the one thing that keeps jumping out at me is the radiation component. I work in a lead apron in a room with x-ray all day and have for 10+ years. I recently changed jobs and although I am still working in a procedure room with x-ray, I am much further away than I was in my previous position.
Michelle
We are not discussing surgery yet. I am on supplemental D and now starting calcium supplement.(seems counterintuitive). I also have to have a 24-hour urine, but based upon what I have read in this forum, it is possible that I will need that also from the hematologist-oncologist, so I am holding off a week in hopes that I only need to do it once.
Again, I am learning a lot reading through all the posts and the one thing that keeps jumping out at me is the radiation component. I work in a lead apron in a room with x-ray all day and have for 10+ years. I recently changed jobs and although I am still working in a procedure room with x-ray, I am much further away than I was in my previous position.
Michelle
7 posts
• Page 1 of 1
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