My father received some scary results today and I’m trying to figure out if he could have multiple myeloma. He’s 42 and he was told to take these tests due to his anemia and high kappa light chain level.
His hemoglobin is 11.9 (L) and hematocrit is 36.4 (L).
His kappa light chain is 30.2 (H)
Lambda light chain 13.8
Kappa-lambda ratio 2.19 (H)
His immunofixation electrophoresis result is:
NO MONOCLONAL PROTEIN DETECTED
His protein electrophoresis is:
Protein, Total 7.4
Albumin 4.5
Alpha-1-Globulins 0.3
Alpha-2-Globulins 0.6
Serum Beta-1 Glob. Fraction 0.4
Serum Beta-2 Glob. Fraction 0.3
Gamma Globulins 1.3
Interpretation:
Normal Electrophoretic Pattern
I was told ratios outside the normal range are attributed to the presence of monoclonal free light chains which are found in the serum of patients with multiple myeloma. I’m trying to make sense of all this. His hemoglobin keeps plummeting and I’m wondering if it’s due to the possibility of bone marrow cancer? Should we expect the news of multiple myeloma? He takes a bone marrow aspiration and biopsy on the 30th of this month.
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Re: High kappa-lambda ratio, but no monoclonal protein?
Hi Flowers,
Are the results you reported for your father all for blood (serum) tests, rather than urine tests?
Also, are the light chain results for a serum (blood) FREE light chain test, rather than a TOTAL light chain test?
Finally, how are your father's kidneys? For example, what is his serum creatinine level?
Are the results you reported for your father all for blood (serum) tests, rather than urine tests?
Also, are the light chain results for a serum (blood) FREE light chain test, rather than a TOTAL light chain test?
Finally, how are your father's kidneys? For example, what is his serum creatinine level?
Re: High kappa-lambda ratio, but no monoclonal protein?
Yes, they’re all serum tests.
For your second question, according to the labs, it's titled:
Free Kappa/Lambda Light Chains Qnt (Serum)
He doesn’t have a copy of any urine labs since he was told his kidneys are fine. They did find blood in his urine which is why they ran these tests in the first place, including his anemia.
For your second question, according to the labs, it's titled:
Free Kappa/Lambda Light Chains Qnt (Serum)
He doesn’t have a copy of any urine labs since he was told his kidneys are fine. They did find blood in his urine which is why they ran these tests in the first place, including his anemia.
Re: High kappa-lambda ratio, but no monoclonal protein?
Hi Flowers,
The serum immunofixation test is a rather sensitive test. Since it's negative for any monoclonal protein whatsoever, it's suggesting that the reason your father's kappa free light chain level is elevated is because excess polyclonal (not monoclonal) kappa light chains are floating free in his blood.
Also, although your father's kappa-lambda ratio of 2.19 is outside the normal range, it is not excessively outside the normal range, which is 0.26 - 1.65.
In addition, if your father's kidneys are in fact damaged to some extent, then the reference range for the kappa-lambda level is actually different from what I've listed above. It's 0.37 - 3.10, instead of 0.26 - 1.65. In other words, your father's "high" kappa-lambda ratio would be within the reference range relevant to him if he has some kidney damage.
I will say that is possible that the free light chain test results are picking up signs of monoclonal light chains that aren't being picked up by the serum immunofixation test. This article,
http://www.pathologyjournal.rcpa.edu.au/article/S0031-3025(16)30431-7/pdf
says that, in about 6 percent of cases where the free light chain test shows signs of monoclonal kappa free light chains, the serum immunofixation test comes up negative. The article doesn't say, though, which test is typically correct in those 6 percent of cases -- the free light chain test, or the immunofixation test.
So it's good that your father will be getting a bone marrow biopsy.
If I were you, I also would be looking closely at his lab results to see if there are any signs whatsoever of impaired kidney function. What sort of imaging has your father had done (ultrasounds, x-rays, MRIs, CT scans, PET/CTs), and of what parts of his body?
Good luck, and please let us know what you find out.
The serum immunofixation test is a rather sensitive test. Since it's negative for any monoclonal protein whatsoever, it's suggesting that the reason your father's kappa free light chain level is elevated is because excess polyclonal (not monoclonal) kappa light chains are floating free in his blood.
Also, although your father's kappa-lambda ratio of 2.19 is outside the normal range, it is not excessively outside the normal range, which is 0.26 - 1.65.
In addition, if your father's kidneys are in fact damaged to some extent, then the reference range for the kappa-lambda level is actually different from what I've listed above. It's 0.37 - 3.10, instead of 0.26 - 1.65. In other words, your father's "high" kappa-lambda ratio would be within the reference range relevant to him if he has some kidney damage.
I will say that is possible that the free light chain test results are picking up signs of monoclonal light chains that aren't being picked up by the serum immunofixation test. This article,
http://www.pathologyjournal.rcpa.edu.au/article/S0031-3025(16)30431-7/pdf
says that, in about 6 percent of cases where the free light chain test shows signs of monoclonal kappa free light chains, the serum immunofixation test comes up negative. The article doesn't say, though, which test is typically correct in those 6 percent of cases -- the free light chain test, or the immunofixation test.
So it's good that your father will be getting a bone marrow biopsy.
If I were you, I also would be looking closely at his lab results to see if there are any signs whatsoever of impaired kidney function. What sort of imaging has your father had done (ultrasounds, x-rays, MRIs, CT scans, PET/CTs), and of what parts of his body?
Good luck, and please let us know what you find out.
Re: High kappa-lambda ratio, but no monoclonal protein?
In addition to Terry's great comments, your father's doctor is probably also on the lookout for lymphoma, which can cause abnormal polyclonal free light chain values and anemia. Lymphoma can also be diagnosed via a bone marrow biopsy.
If one suspects lymphoma and you are looking at his CBC test results, you would want to check if his white blood cell (WBC) and platelet levels are low (although experiencing either of these events wouldn't necessarily mean a diagnosis of lymphoma).
If one suspects lymphoma and you are looking at his CBC test results, you would want to check if his white blood cell (WBC) and platelet levels are low (although experiencing either of these events wouldn't necessarily mean a diagnosis of lymphoma).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa-lambda ratio, but no monoclonal protein?
Terry - Thank you. I will have my father request his lab results from a urologist and get back to you on what I find. But from all the information I’ve given you here so far, would you say it’s unlikely my father has multiple myeloma?
Multibilly - According to his CBC, his WBC and platelet count are normal.
White Blood Cells 5.5
Platelet Count 184
I’m wondering if I should be prepared to hear the possible news of lymphoma or multiple myeloma? November 30th is a long time to wait for, in my perspective, considering his kappa/lambda ratio is abnormal, and we’d have to wait another week for the results.
Thank you.
Multibilly - According to his CBC, his WBC and platelet count are normal.
White Blood Cells 5.5
Platelet Count 184
I’m wondering if I should be prepared to hear the possible news of lymphoma or multiple myeloma? November 30th is a long time to wait for, in my perspective, considering his kappa/lambda ratio is abnormal, and we’d have to wait another week for the results.
Thank you.
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