I have received my lab results (online EMR) and will meet with a hematologist next week. I'm a little confused, because the reference range values seem to be different than what I see mentioned on various sites (lambda 0.57-2.63 mg/dL, kappa 0.33 - 1.94 mg/dL).
Here are my results and the reference ranges listed:
K/L light chain ratio, free, serum : Result: 2.4 Reference Range: 1.47 || 2.95
Lambda light chain, free, serum, mg/dL : Results: 223 mg/dL Reference Range: 325.0 || 725.0
Kappa light chain, free, serum, mg/dL : Result: 536 mg/dL Reference Range: 625.0 || 1350.0
IgG, quant : Result: 438 mg/dL Reference Range: 750.0 || 1550.0
Can anyone help clear up my confusion?
Thanks, Gregg
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Re: Free light chains - reference values / units
Gregg,
Are you in the USA?
This is indeed confusing. The serum Freelite(R) chain assay is the only FDA approved serum free light chain test in the USA, and the reference ranges you cited are correct and are standardized for that particular test.
Your units of measure for your actual lab values also seem correct (sometimes, labs will use different units of measure and this will change results by a factor of 10 and you have to then convert the results, but that's not the case here).
Your IgG is pretty low (if these numbers are accurate ... which I now question). What are your other immuoglobulin levels (IgA, IgM, etc)?
Maybe I am missing something here and others on the forum might have an idea about what's going on? My only guess is that they didn't use the standard serum freelite chain assay test?
Are you in the USA?
This is indeed confusing. The serum Freelite(R) chain assay is the only FDA approved serum free light chain test in the USA, and the reference ranges you cited are correct and are standardized for that particular test.
Your units of measure for your actual lab values also seem correct (sometimes, labs will use different units of measure and this will change results by a factor of 10 and you have to then convert the results, but that's not the case here).
Your IgG is pretty low (if these numbers are accurate ... which I now question). What are your other immuoglobulin levels (IgA, IgM, etc)?
Maybe I am missing something here and others on the forum might have an idea about what's going on? My only guess is that they didn't use the standard serum freelite chain assay test?
Last edited by Multibilly on Sat May 03, 2014 10:18 am, edited 1 time in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Free light chains - reference values / units
Yes, I am in the US.
Here are some of my other results:
IgM, quant Result: 52 mg/dL Range: 45.0 || 300.0
IgA, quant Result: 111 mg/dL Range: 80.0 || 450.0
Gamma globulin Result: 0.45 g/dL Range: 0.59 || 1.46
Beta globulin Result: 0.6 g/dL Range: 0.52 || 1.05
Alpha-2 globulin Result: 0.55 g/dL Range: 0.44 || 1.03
Alpha-1 globulin Result: 0.25 g/dL Range: 0.19 || 0.42
LY % Result: 52.7% Range: 14.0 || 41.0
LY # Result: 6.4 x 10^3/uL Range: 0.4 || 3.6
WBC Result: 12.2 x 10^3/uL Range: 3.0 || 8.9
RBC Result: 4.47 x 10^6/uL Range: 4.2 || 5.6
Thanks for your help, Gregg
Here are some of my other results:
IgM, quant Result: 52 mg/dL Range: 45.0 || 300.0
IgA, quant Result: 111 mg/dL Range: 80.0 || 450.0
Gamma globulin Result: 0.45 g/dL Range: 0.59 || 1.46
Beta globulin Result: 0.6 g/dL Range: 0.52 || 1.05
Alpha-2 globulin Result: 0.55 g/dL Range: 0.44 || 1.03
Alpha-1 globulin Result: 0.25 g/dL Range: 0.19 || 0.42
LY % Result: 52.7% Range: 14.0 || 41.0
LY # Result: 6.4 x 10^3/uL Range: 0.4 || 3.6
WBC Result: 12.2 x 10^3/uL Range: 3.0 || 8.9
RBC Result: 4.47 x 10^6/uL Range: 4.2 || 5.6
Thanks for your help, Gregg
Re: Free light chains - reference values / units
I'm not a doc, but one usually sees one of your immunoglobulins and a free light chain elevated with multiple myeloma. Your immunoglobulins are on the low side (or below normal in the case of your IgG), so I'm guessing that we aren't talking about a monoclonal gammopathy like multiple myeloma.
Instead, you might just be looking at at an infection, so you likely don't belong on this forum ... which is a good thing
http://www.hopkinsmedicine.org/healthlibrary/conditions/allergy_and_asthma/igg_deficiencies_134,109/
But a doc really needs to comment on this.
I have no clue what to make of the free light reference ranges in your lab results.
Instead, you might just be looking at at an infection, so you likely don't belong on this forum ... which is a good thing
http://www.hopkinsmedicine.org/healthlibrary/conditions/allergy_and_asthma/igg_deficiencies_134,109/
But a doc really needs to comment on this.
I have no clue what to make of the free light reference ranges in your lab results.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Free light chains - reference values / units
I am IgG lambda and also have low numbers for the Ig factions. My IgG is 589 mg/dL: IgA is 88; and IgM is 73. So far I am diagnosed as MGUS. I haven't gotten an explanation that makes sense to me as to why the IgG is so low. It seems contradictory to anything I have seen so far. I also have a FLC ratio of 0.09.
I've been wondering if we're barking up the wrong tree. I don't have any bone marrow biopsy results as my last test was contaminated and I will have it redone this next week. I am also due to have my third sinus surgery (20 months of sinus infections) in a few weeks after I get the results of the bone marrow biopsy [BMB]. Hopefully, the BMB will give me some answers.
Thanks, Kay
I've been wondering if we're barking up the wrong tree. I don't have any bone marrow biopsy results as my last test was contaminated and I will have it redone this next week. I am also due to have my third sinus surgery (20 months of sinus infections) in a few weeks after I get the results of the bone marrow biopsy [BMB]. Hopefully, the BMB will give me some answers.
Thanks, Kay
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Kay - Name: Kay Wilson
- Who do you know with myeloma?: SMM
- When were you/they diagnosed?: 2014
- Age at diagnosis: 72
Re: Free light chains - reference values / units
I have light chain only myeloma. At the time of diagnosis, all three of my Ig's were low, i.e. immune paresis. This is different for the majority variant of multiple myeloma where an Ig (usually IgG) is hijacked and is very elevated and the others are low or normal.
Immune paresis with all three Ig's is a common finding with true light chain only myeloma, about 20% of multiple myeloma.
Immune paresis with all three Ig's is a common finding with true light chain only myeloma, about 20% of multiple myeloma.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Free light chains - reference values / units
Hey Terry:
But Gregg's light chains are also all suppressed.
I would expect one of Gregg's light chains to be elevated if he had light chain restricted myeloma in play, right? Putting aside the peculiar reference ranges for Gregg's light chain lab values, I don't believe there is a multiple myeloma scenario where both of the light chain levels are depressed, and all the immunogloblulin levels are normal or depressed as well?
Kay, in your situation, it does sounds like light chain restricted MGUS (which happens in about 20% of multiple myeloma patients, as Terry said) and an immuno paresis phenomena where your IgG is suppressed (again, as Terry said). So this isn't totally out of the ordinary. A BMB will indeed confirm if you've got MGUS in play. Good luck with that.
Again, I'm not a doc, so take this all with a grain of salt
But Gregg's light chains are also all suppressed.
I would expect one of Gregg's light chains to be elevated if he had light chain restricted myeloma in play, right? Putting aside the peculiar reference ranges for Gregg's light chain lab values, I don't believe there is a multiple myeloma scenario where both of the light chain levels are depressed, and all the immunogloblulin levels are normal or depressed as well?
Kay, in your situation, it does sounds like light chain restricted MGUS (which happens in about 20% of multiple myeloma patients, as Terry said) and an immuno paresis phenomena where your IgG is suppressed (again, as Terry said). So this isn't totally out of the ordinary. A BMB will indeed confirm if you've got MGUS in play. Good luck with that.
Again, I'm not a doc, so take this all with a grain of salt
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Free light chains - reference values / units
I am not exactly sure of the lab values that you describe.
Freelite assays are the test that is utilized within the US to quantify the amount of free light chain in your serum (and can be done on urine in cases of AL). What is important to understand is that this assay measures only the light chains that are "floating" in your blood not associated with heavy chains.
All functional antibodies exist as a associated heavy and light chains, bound together. However, myeloma cells can produce more light chains that heavy chains and thus leave them without partner. These are the light chains being measured in the Freelite assay, the assay that we use to monitor plasma cell disorders (MGUS, myeloma, amyloidosis, ... ).
There is also an assay/test to measure total light chains, both free and associated with heavy chains. The reference ranges are higher. I just looked up the values for Quest:
Reference Range(s)
Kappa: 74-295 mg/dL
Lambda: 32-156 mg/dL
Kappa/Lambda Ratio: 1.3-2.7
These are still different than that values that you noted. However, this likely represents another lab's range (?). The labs occasionally run this by mistake, I would recommend that you have the tests repeated (appropriately with Freelite assay).
WIth your labs there is not a lot (really any) evidence of a clonal plasma cell disorder. I agree that getting a proper bone marrow biopsy, assessing hemoglobin, calcium, and creatinine is important, as well as imaging (bone survey and potentially PET/CT and/or MRI). Although rare with SPEP-IFE, UPEP-IFE and SFLC, there is still 1% of multiple myeloma patients that who will be true non-secreters. If these lab results "normal", this would effectively rule out a plasme cell disorder.
Keep us informed.
Freelite assays are the test that is utilized within the US to quantify the amount of free light chain in your serum (and can be done on urine in cases of AL). What is important to understand is that this assay measures only the light chains that are "floating" in your blood not associated with heavy chains.
All functional antibodies exist as a associated heavy and light chains, bound together. However, myeloma cells can produce more light chains that heavy chains and thus leave them without partner. These are the light chains being measured in the Freelite assay, the assay that we use to monitor plasma cell disorders (MGUS, myeloma, amyloidosis, ... ).
There is also an assay/test to measure total light chains, both free and associated with heavy chains. The reference ranges are higher. I just looked up the values for Quest:
Reference Range(s)
Kappa: 74-295 mg/dL
Lambda: 32-156 mg/dL
Kappa/Lambda Ratio: 1.3-2.7
These are still different than that values that you noted. However, this likely represents another lab's range (?). The labs occasionally run this by mistake, I would recommend that you have the tests repeated (appropriately with Freelite assay).
WIth your labs there is not a lot (really any) evidence of a clonal plasma cell disorder. I agree that getting a proper bone marrow biopsy, assessing hemoglobin, calcium, and creatinine is important, as well as imaging (bone survey and potentially PET/CT and/or MRI). Although rare with SPEP-IFE, UPEP-IFE and SFLC, there is still 1% of multiple myeloma patients that who will be true non-secreters. If these lab results "normal", this would effectively rule out a plasme cell disorder.
Keep us informed.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Free light chains - reference values / units
Hi Gregg,
For what it's worth ...
Results from a lab that my samples were sent to also indicated a range of 625-1350 and 325-725 mg/dl respectively for kappa and lambda light chain values. Those results indicated below normal values for both. However, within a four day period (getting second opinions), I also had the more standard Freelite test done on samples. Those results indicated a slightly elevated lambda. There certainly did not seem to be a strong agreement between the tests.
Scott
For what it's worth ...
Results from a lab that my samples were sent to also indicated a range of 625-1350 and 325-725 mg/dl respectively for kappa and lambda light chain values. Those results indicated below normal values for both. However, within a four day period (getting second opinions), I also had the more standard Freelite test done on samples. Those results indicated a slightly elevated lambda. There certainly did not seem to be a strong agreement between the tests.
Scott
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