Hi,
I'm a 54 year old woman and I've just been diagnosed with an enchondroma in my iliac region. I've just been diagnosed with osteopenia due to having multiple broken vertebrae in my thoracic spine from just twisting in my car. My DEXA scan only showed osteopenia.
My bloods from a few months ago showed that they had rouleaux formation and I also have raised globulin levels. I also have kidney stones, and a small meningioma in my brain. I've previously had a phaeochromocytoma which was removed. I also have Behcets and Sjogrens.
After having had so many illnesses in my life, I'm just a bit unsure.
I have a lot of back pain and am just wondering whether to put up with it or go back to my doctor. I'm 5'6" (1.68 m)..well I was, before I broke the vertebrae but I have lost a couple of inches. I weigh 93 kg (205 pounds). I'd really appreciate any input. Thankyou in advance.
Blood tests now show:
IgA is high 27.4 g/l (0.8- 4) high
IgG is low at 5.9 g/l (7-16) low
GGT is 71 u/l. (<50) h
Total protein 85 (66-84) h
Globulin 53 g/l (25-41) h
Apparently they are now doing a blood electrophoresis test, which I am waiting for the results, but of course my mind is going around in circles.
I actually wondered if I had multiple myeloma when they diagnosed me with osteopenia, due to the fact I had breaks in my spine and the density is not bad.
Would appreciate any comments
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8 posts
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Re: High IgA with low IgG - is it multiple myeloma?
Hi Notanotherone,
Welcome to the forum.
You have certainly have a lot going on and I feel for you.
I assume that your electrophoresis test is part of an overall electrophoresis / immunofixation test.
Your elevated IgA could be due to your Sjogrens disease, so it's tough to say if that elevated IgA level would be in part due to a plasma cell dyscrasia such as multiple myeloma. So, unfortunately, you are going to have to wait until you get back the results of your electrophoresis test to be able to better rule out something like multiple myeloma. I'm certainly not a doctor, but what strikes me is that you are only 54 and I don't think all of the damage to your spine would be normally explained by your other conditions.
If the upcoming test does show the presence of a monoclonal protein, I might suggest getting a follow-up PET/CT or MRI of your spine (I'm assuming your enchondroma was diagnosed via an x-ray) to verify if there is any myeloma-related damage in your spine. In fact, it might be good to do some follow up advanced imaging even if you don't have any monoclonal protein in your blood.
Also, has your doctor discussed putting you on a bisphosphonate to help with your fragile bones? I might also suggest seeing an orthopedic surgeon that specializes in spines to see if something like kyphoplasty might be something to consider for stabilizing your spine.
Welcome to the forum.
You have certainly have a lot going on and I feel for you.
I assume that your electrophoresis test is part of an overall electrophoresis / immunofixation test.
Your elevated IgA could be due to your Sjogrens disease, so it's tough to say if that elevated IgA level would be in part due to a plasma cell dyscrasia such as multiple myeloma. So, unfortunately, you are going to have to wait until you get back the results of your electrophoresis test to be able to better rule out something like multiple myeloma. I'm certainly not a doctor, but what strikes me is that you are only 54 and I don't think all of the damage to your spine would be normally explained by your other conditions.
If the upcoming test does show the presence of a monoclonal protein, I might suggest getting a follow-up PET/CT or MRI of your spine (I'm assuming your enchondroma was diagnosed via an x-ray) to verify if there is any myeloma-related damage in your spine. In fact, it might be good to do some follow up advanced imaging even if you don't have any monoclonal protein in your blood.
Also, has your doctor discussed putting you on a bisphosphonate to help with your fragile bones? I might also suggest seeing an orthopedic surgeon that specializes in spines to see if something like kyphoplasty might be something to consider for stabilizing your spine.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgA with low IgG - is it multiple myeloma?
Hello Notanotherone,
Thanks for posting to the forum, and hope you can get some clarity regarding osteopenia, fractures and multiple myeloma. Multibilly, as usual, has given wise advice.
As well as the SPEP test, would you be getting the serum free light chain test (SFLC), either by serum or urine, and also blood tests for kidney function, excess calcium in the blood and anemia? The acronym CRAB applies to myeloma: calcium in blood, renal function, anemia, and bone damage. Any of those could be a symptom of myeloma.
I had a similar situation in my late fifties, with being diagnosed with osteopenia. After some months, and having had vertebral fractures as well as diffuse lytic lesions, the cancer diagnosis was confirmed by the blood, urine, and bone marrow biopsy tests. Although I was very disappointed to have multiple myeloma, the treatments I got, which did include bisphosphonate treatments for my friable bones, got me into a good remission. After all of these treatments, my skeletal problems have improved a lot. Stopping the myeloma cancer is very important for bone strength!
Thanks for posting to the forum, and hope you can get some clarity regarding osteopenia, fractures and multiple myeloma. Multibilly, as usual, has given wise advice.
As well as the SPEP test, would you be getting the serum free light chain test (SFLC), either by serum or urine, and also blood tests for kidney function, excess calcium in the blood and anemia? The acronym CRAB applies to myeloma: calcium in blood, renal function, anemia, and bone damage. Any of those could be a symptom of myeloma.
I had a similar situation in my late fifties, with being diagnosed with osteopenia. After some months, and having had vertebral fractures as well as diffuse lytic lesions, the cancer diagnosis was confirmed by the blood, urine, and bone marrow biopsy tests. Although I was very disappointed to have multiple myeloma, the treatments I got, which did include bisphosphonate treatments for my friable bones, got me into a good remission. After all of these treatments, my skeletal problems have improved a lot. Stopping the myeloma cancer is very important for bone strength!
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: High IgA with low IgG - is it multiple myeloma?
Thank you both for your input and comments, I really appreciate that, as I have no one to really talk to.
I did forget to add that I’m actually on immunosuppressant drugs, so those results may be lower than they could be. Plus, I have learnt that Imuran (azathioprine) can cause multiple myeloma.
I’m thinking that I may have a chat with my doctor tomorrow depending whether my electrophoresis test is back.
With regard to CRAB, my calcium results were fine a few months ago, my renal function tests are so far ok, but I have multiple kidney stones. My liver function isn’t great, with raised globulin, protein and GGT. I’m always slightly anaemic but haven’t had an iron injection for a while. Bone wise, I’ve got multiple vertebral fractures, a broken rib and a lesion on my pelvis.
They thought about putting me on bisphosphonates, but they weren’t keen as I’m on so many other drugs, and I didn’t want to due to fear of the side effects. I was supposed to go to my dentist to get clearance to take them; haven’t done that yet.
I’m just at the start of testing, so I guess all will depend on the electrophoresis test in the next few days.
Thank you again for taking the time to chat back to me. I’m sorry that you have both found yourselves with this wee challenge. I look forward to getting to know everyone if I find myself permanently here.
P.S.: I’m in New Zealand, so excuse tardy replies. I’m asleep when you write
I did forget to add that I’m actually on immunosuppressant drugs, so those results may be lower than they could be. Plus, I have learnt that Imuran (azathioprine) can cause multiple myeloma.
I’m thinking that I may have a chat with my doctor tomorrow depending whether my electrophoresis test is back.
With regard to CRAB, my calcium results were fine a few months ago, my renal function tests are so far ok, but I have multiple kidney stones. My liver function isn’t great, with raised globulin, protein and GGT. I’m always slightly anaemic but haven’t had an iron injection for a while. Bone wise, I’ve got multiple vertebral fractures, a broken rib and a lesion on my pelvis.
They thought about putting me on bisphosphonates, but they weren’t keen as I’m on so many other drugs, and I didn’t want to due to fear of the side effects. I was supposed to go to my dentist to get clearance to take them; haven’t done that yet.
I’m just at the start of testing, so I guess all will depend on the electrophoresis test in the next few days.
Thank you again for taking the time to chat back to me. I’m sorry that you have both found yourselves with this wee challenge. I look forward to getting to know everyone if I find myself permanently here.
P.S.: I’m in New Zealand, so excuse tardy replies. I’m asleep when you write
Re: High IgA with low IgG - is it multiple myeloma?
New test results so far:
Serum free light chains: Undetected antigen excess is a rare event but cannot be excluded. If these free light chains results do not accord with other clinical or laboratory findings, please alert LabPlus so that further investigations can be made.
Serum free kappa light chains: 47 mg/L ( 3-19 ) H
Serum free lambda light chains:83 mg/L ( 6-26 ) H
Serum kappa/lambda ratio. 0.56 (0.26-1.65 )
Note raised ESR, causes:
Infection / inflammation, renal impairment, malignancy, connective tissue disorders and temporal arteritis. If cause is unclear, suggest review.
ESR: 124 multiple myeloma/hr ( < 31 ) H
Lymphocytes 0.66x10 e9/l (1-4)
I do normally have rouleaux formation in the blood
I have multiple broken vertebrae and a pelvic “lucent” lesion
Getting a little more nervous.
Serum free light chains: Undetected antigen excess is a rare event but cannot be excluded. If these free light chains results do not accord with other clinical or laboratory findings, please alert LabPlus so that further investigations can be made.
Serum free kappa light chains: 47 mg/L ( 3-19 ) H
Serum free lambda light chains:83 mg/L ( 6-26 ) H
Serum kappa/lambda ratio. 0.56 (0.26-1.65 )
Note raised ESR, causes:
Infection / inflammation, renal impairment, malignancy, connective tissue disorders and temporal arteritis. If cause is unclear, suggest review.
ESR: 124 multiple myeloma/hr ( < 31 ) H
Lymphocytes 0.66x10 e9/l (1-4)
I do normally have rouleaux formation in the blood
I have multiple broken vertebrae and a pelvic “lucent” lesion
Getting a little more nervous.
Re: High IgA with low IgG - is it multiple myeloma?
Hello Notanotherone,
Thanks for sharing your lab results. Do you get them ahead of time from you doctor's consult, or have you already discussed them with the doctor?
I am not a doctor, and did not know what 'rouleaux' in the blood were, until looking them up. They are stacks of red blood cells which could occur in multiple myeloma , but also with some other diseases.
The results of bone damage and a 'lucent' lesion could be one of the CRAB criteria for myeloma. Hope you get some clarity on what the problems are! In my own case, getting the diagnosis was half the battle, since then I could get treatments for myeloma. Best wishes, and let us know how this turns out!
Thanks for sharing your lab results. Do you get them ahead of time from you doctor's consult, or have you already discussed them with the doctor?
I am not a doctor, and did not know what 'rouleaux' in the blood were, until looking them up. They are stacks of red blood cells which could occur in multiple myeloma , but also with some other diseases.
The results of bone damage and a 'lucent' lesion could be one of the CRAB criteria for myeloma. Hope you get some clarity on what the problems are! In my own case, getting the diagnosis was half the battle, since then I could get treatments for myeloma. Best wishes, and let us know how this turns out!
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: High IgA with low IgG - is it multiple myeloma?
Hello Notanotherone,
In general, when both your kappa and lambda FLCs are high and your ratio is normal, this doesn't normally signify myeloma, but rather something like an infection or kidney issues.
WRT to whether this might be myeloma, the key lab test is the serum immunofixation test, which will tell you if any of your free light chains or heavy chains (immunoglobulins such as IgA) are monoclonal (cancerous) or not. A "lucent" lesion may or not be due to something like myeloma.
Just like your elevated IgA, rouleaux formations in your blood can also be caused by your Sjorgen's disease, or as Nancy mentioned, by some other disease other than myeloma.
In general, when both your kappa and lambda FLCs are high and your ratio is normal, this doesn't normally signify myeloma, but rather something like an infection or kidney issues.
WRT to whether this might be myeloma, the key lab test is the serum immunofixation test, which will tell you if any of your free light chains or heavy chains (immunoglobulins such as IgA) are monoclonal (cancerous) or not. A "lucent" lesion may or not be due to something like myeloma.
Just like your elevated IgA, rouleaux formations in your blood can also be caused by your Sjorgen's disease, or as Nancy mentioned, by some other disease other than myeloma.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgA with low IgG - is it multiple myeloma?
Hi everyone,
I have been to see a rheumatologist and finally they are doing some more tests including the Bence-Jones in the urine. He doesn’t seem to think it’s bone disease as such, but is going to put me on infusions of bisphosphonates. I guess I will know more definitively what it’s not, this week. He said it wasn’t autoimmune due to my CRP not being raised, although my ESR was 127.
Bodies are such a joy, aren’t they? My immune system is not happy though; I’ve just caught another cold.
Anyway, just wanted to thank you guys very much for your very informative and helpful replies. I’m so sorry you are dealing with this situation yourselves, but thank you for your help to other sick people.
I have been to see a rheumatologist and finally they are doing some more tests including the Bence-Jones in the urine. He doesn’t seem to think it’s bone disease as such, but is going to put me on infusions of bisphosphonates. I guess I will know more definitively what it’s not, this week. He said it wasn’t autoimmune due to my CRP not being raised, although my ESR was 127.
Bodies are such a joy, aren’t they? My immune system is not happy though; I’ve just caught another cold.
Anyway, just wanted to thank you guys very much for your very informative and helpful replies. I’m so sorry you are dealing with this situation yourselves, but thank you for your help to other sick people.
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