[rluck9974]

High kappa / lambda ratio - worried

by rluck9974 on Thu May 26, 2016 1:53 pm

Hi,

I recently had blood work done by a neurologist after ruling out ALS because of numbness and pain in my feet. ALS was ruled out by EMG.

After reading through this forum, I am still confused on what the high kappa/lambda ratio could mean considering every test which is associated with this results have been negative. Do I need to worry about this as so far my doctor has not contacted me but I do have an appointment scheduled for followup.

Thanks in advance for anyone that has any info

Free Kappa Light Chain 11.5
Free Lambda Light Chain 3.1
Free Kappa/Lambda Ratio 3.71

All blood work has been negative except for the kappa results. I was also tested for autommune disorders which came back negative.

IMMUNOGLOBULIN A 173 81-463 mg/dL EN

IMMUNOFIXATION, SERUM

Interpretation - Normal pattern. No monoclonal proteins detected.

PROTEIN, TOTAL AND PROTEIN ELECTROPHORESIS

PROTEIN, TOTAL 7.3 6.1-8.1 g/dL
ALBUMIN 4.8 3.8-4.8 g/dL
ALPHA 1 GLOBULIN 0.3 0.2-0.3 g/dL
ALPHA 2 GLOBULIN 0.6 0.5-0.9 g/dL
BETA 1 GLOBULIN 0.4 0.4-0.6 g/dL
BETA 2 GLOBULIN 0.3 0.2-0.5 g/dL
GAMMA GLOBULIN 0.8 0.8-1.7 g/dL

PROTEIN ELECTROPHORESIS

Interpretation - Normal electrophoretic pattern

TISSUE TRANSGLUTAMINASE AB, IGA <1 U/mL EZ
<4 No Antibody Detected
> OR = 4 Antibody Detected

GLIADIN (DEAMIDATED) AB (IGG, IGA) EZ
GLIADIN (DEAMIDATED) AB (IGA) 3 <20 U
Reference Ranges for Gliadin (Deamidated Peptide)
Antibody (IgA):
<20 units Antibody Not Detected
> or = 20 units Antibody Detected

GLIADIN (DEAMIDATED) AB, (IGG) 3 <20 U
Reference Ranges for Gliadin (Deamidated Peptide)
Antibody (IgG):
<20 units Antibody Not Detected
> or = 20 units Antibody Detected

COPPER 99 70-175 mcg/dL SLI

ENDOMYSIAL ANTIBODY SCR (IGA) W/REFL TO TITER
NEGATIVE

[Multibilly]

Re: High kappa / lambda ratio - worried

by Multibilly on Thu May 26, 2016 3:33 pm

Rich,

Are the units of measure "mg/dL" for your kappa and lambda numbers? What are the standard reference ranges for these markers? It these numbers are from a standard serum free light chain assay and the units of measure are in mg/dL, it seems like both your kappa and lambda numbers are elevated.

[rluck9974]

Re: High kappa / lambda ratio - worried

by rluck9974 on Thu May 26, 2016 6:04 pm

Thanks for replying. Here is what the results say.

Kappa Light Chain - 11.5 mg/L, normal range 3.3-19.4
Free Kappa / Lambda Ratio - 3.71 mg/L, normal range 0.26-1.65
Free Lambda - 3.1 mg/L, normal range 5.7-26.3

So just the ratio and the free lambda are not in normal range. I don't know if that makes a dif­fer­ence or not.

[Multibilly]

Re: High kappa / lambda ratio - worried

by Multibilly on Thu May 26, 2016 7:43 pm

Thanks for clarifying the numbers.

A normal kappa + low lambda accompanied by a high kappa/lambda ratio MAY potentially signal some sort of a plasma cell disorder such as MGUS, but it is not a given. There are plasma cell disorders where only the serum free light chains are affected, while the heavy chains (immunoglobulins) are not affected and one's serum immunofixation and protein electrophoresis tests therefore appear as normal.

Given you also have pain/numbness in your feet (which could potentially be interpreted as peripheral neuropathy - a common symptom of various plasma cell disorders), I would suggest being evaluated by a hematologist that specializes in multiple myeloma and related disorders. That sort of specialist should be able to get to the bottom of all this fairly quickly....or might just tell you that this is nothing to be worried about.

If you let us know what city you are in, folks on this site can recommend some myeloma specialists/facilities in your area.

In the meantime, you might also consider asking your current doctor to run a 24 hour urine analysis panel & protein assay.

[rluck9974]

Re: High kappa / lambda ratio - worried

by rluck9974 on Thu May 26, 2016 7:59 pm

I am being seen at UC Irvine Health ALS & Neuromuscular Center in Orange, CA so I would imagine they would probably refer me to a hematologist in that network soon if that's the direction they are going based on my results. These tests were just done last week.

Initially they diagnosed small fiber neuropathy based on the negative EMG results and pain in my legs and feet, which at times has radiated to my hands. I also have hyperreflexia in my knee jerks, so that's why they were doing testing for ALS. I would say it was a good day when the EMG was negative for motor neuron disease.

Thanks

[Multibilly]

Re: High kappa / lambda ratio - worried

by Multibilly on Thu May 26, 2016 8:29 pm

UCI has a multiple myeloma department, so it sounds like you've got one-stop shopping available to you Let us know how things turn out and good luck.

[rluck9974]

Re: High kappa / lambda ratio - worried

by rluck9974 on Thu May 26, 2016 8:43 pm

Yeah that's why I chose UCI since I have a PPO. Excellent hospital and network of doctors and all of the info about visits is connected, so you don't have to repeat it a thousand times every time you see a new doctor.

Hopefully it turns out to be nothing major, but I will keep this thread updated.

Thanks again.

[Little Monkey]

Re: High kappa / lambda ratio - worried

by Little Monkey on Fri May 27, 2016 1:05 pm

Good afternoon,

Have you had an MRI or CT scan of your back yet by any chance?

[rluck9974]

Re: High kappa / lambda ratio - worried

by rluck9974 on Sat May 28, 2016 1:43 am

Yes I had cervical and lower back MRI early on which showed mild to moderate degenerative changes in C5-C6. No problems in lower back.

No CT scan yet.

[Little Monkey]

Re: High kappa / lambda ratio - worried

by Little Monkey on Sat May 28, 2016 8:16 am

Ok, so no masses leaning against the spinal cord. That's what I was concerned about when you mentioned foot pain and numbness.