Hello,
A year ago I was running and working out 4 or 5 times a week, then in May my back went out. Usually when it would do that, I would feel better in a few days to a week, but this time by July things were not much better. My feet were (are) going numb.
To make a long story shorter, I was found to have a ruptured disk again, only this time there is also neuropathy in my legs. In looking for a reason for that, I was found to have an 0.2 g/dl (2 g/L) IgG kappa m-spike.
I have been lurking here for a month or two since then. I just went to the hematologist / oncologist on Monday and had a skeletal survey yesterday. I'm doing the 24 hour urine collection this weekend.
I know the m-spike is small and so far all my tests have been good, but I just looked at the results of my latest tests and something doesn't make sense to me. This time, they did a Immunoglobulins G,M,A test (I don't know what it is really called). I go back to the hematologist the week after next, but I am anxious to understand.
IgG 587 mg/dl (700-1600) Low
IgM 54 mg/dl (50-300)
IgA 166 mg/dl (170-400)
How can my IgG be low if I have an IgG m-spike? Could the original serum immunofixation and SPEP that showed the spike be a false positive, or am I misunderstanding the results?
A week and a half before this test I did get the flu (even though I had the flu shot), in case that makes a difference.
I am new to all this and really do appreciate the work that goes into this site.
Thanks,
Ralph
Forums
7 posts
• Page 1 of 1
Re: New here - IgG M-spike with low IgG; is that possible?
Hey Ralph,
Welcome to the forum!
This is indeed a bit peculiar.
An M-spike of 0.2 g/dL = 200 mg/dL. This is indeed a pretty small M-spike, which is great. But that would mean that your "healthy" IgG level would only be about 387 mg/dL (= 587-200).
I'm not a doctor, but maybe you have an IgG deficiency in play here? I really don't know if the flu would lower your IgG like this.
Did they measure your serum lambda and kappa free light chains? That might provide another clue.
Since you are having some bone issues, was your calcium level elevated? Also was your hemaglobin (Hgb) low or was your creatinine high?
I bet your hematologist will suggest getting re-tested in the near future to see if these lab results were accurate. The laboratories sometimes do mess up.
Others on the forum may have some other ideas ...
Good luck with your future lab test results.
Welcome to the forum!
This is indeed a bit peculiar.
An M-spike of 0.2 g/dL = 200 mg/dL. This is indeed a pretty small M-spike, which is great. But that would mean that your "healthy" IgG level would only be about 387 mg/dL (= 587-200).
I'm not a doctor, but maybe you have an IgG deficiency in play here? I really don't know if the flu would lower your IgG like this.
Did they measure your serum lambda and kappa free light chains? That might provide another clue.
Since you are having some bone issues, was your calcium level elevated? Also was your hemaglobin (Hgb) low or was your creatinine high?
I bet your hematologist will suggest getting re-tested in the near future to see if these lab results were accurate. The laboratories sometimes do mess up.
Others on the forum may have some other ideas ...
Good luck with your future lab test results.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: New here - IgG M-spike with low IgG; is that possible?
Thank you for your reply,
I don't see anything on the tests about lambda and kappa free light chains. Creatinine and hemoglobin are normal,
Creatinine 0.9 mg/dl (0.7 - 1.2)
HGB 16.6 g/dl (13.0 - 18.0)
The only other things on the tests that I see that are out of bounds is globulin:
Albumin 4.4 g/dl (3.2 - 4.8)
Globulin 1.9 g/dl (2.4 - 4.3) Low
Ralph.
I don't see anything on the tests about lambda and kappa free light chains. Creatinine and hemoglobin are normal,
Creatinine 0.9 mg/dl (0.7 - 1.2)
HGB 16.6 g/dl (13.0 - 18.0)
The only other things on the tests that I see that are out of bounds is globulin:
Albumin 4.4 g/dl (3.2 - 4.8)
Globulin 1.9 g/dl (2.4 - 4.3) Low
Ralph.
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rlyman40 - Name: Ralph Lyman
- When were you/they diagnosed?: 11/2014
- Age at diagnosis: 55
Re: New here - IgG M-spike with low IgG; is that possible?
Many patients with monoclonal gammopathies (MGUS, smoldering myeloma, or active myeloma) have suppression of their normal immunoglobulin production, so quantitative measures of IgG, IgA, and IgM can be low.
Your IgG kappa M-spike (0.2, or 200 mg/dL) is very small, so when there is suppression of your normal IgG, the total IgG still comes out low. Your IgM and IgA are low, or low-normal, as well, supporting this observation.
This may make you somewhat more susceptible to infections, but is not diagnostic of myeloma in and of itself. Your hematologist should be able to go over all the test results with you in more detail.
Good luck!
Your IgG kappa M-spike (0.2, or 200 mg/dL) is very small, so when there is suppression of your normal IgG, the total IgG still comes out low. Your IgM and IgA are low, or low-normal, as well, supporting this observation.
This may make you somewhat more susceptible to infections, but is not diagnostic of myeloma in and of itself. Your hematologist should be able to go over all the test results with you in more detail.
Good luck!
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: New here - IgG M-spike with low IgG; is that possible?
Thank you for your reply,
I had a follow up with my doctor today and he told me the same thing just after he told me that they think they found a small lesion on my skull. I am getting a bone marrow biopsy tomorrow and he is going to schedule a different kind of scan -- PET / CT, MRI, ??; I am not sure which one yet. I was all set with what I was expecting him to tell me (that it was MGUS, levels are very low, and see him again in 3 months). I am still trying to digest this new news and, needless to say, I am a bit more nervous now.
Thanks again for all you do here.
Ralph
I had a follow up with my doctor today and he told me the same thing just after he told me that they think they found a small lesion on my skull. I am getting a bone marrow biopsy tomorrow and he is going to schedule a different kind of scan -- PET / CT, MRI, ??; I am not sure which one yet. I was all set with what I was expecting him to tell me (that it was MGUS, levels are very low, and see him again in 3 months). I am still trying to digest this new news and, needless to say, I am a bit more nervous now.
Thanks again for all you do here.
Ralph
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rlyman40 - Name: Ralph Lyman
- When were you/they diagnosed?: 11/2014
- Age at diagnosis: 55
Re: New here - IgG M-spike with low IgG; is that possible?
Hello Ralph,
Sorry to hear that you may have a lesion in your skull. I could understand how that, combined with the discussion you had with your doctor, could be causing you a lot of concern.
Before you jump to conclusions, one thing you should know is that the skull is an area of the body where x-rays often show what look like lytic lesions, but the lesions are not actually myeloma-related. Instead, they are what are known as "venous lakes".
I had never heard about this until I started reading postings here in the forum. Dr. Shain, one of the myeloma specialists who helps out here in the forum, describes how venous lakes are sometimes misdiagnosed as lytic lesions in this posting.
I also found this poster presentation that discusses skull lytic lesions and venous lakes. It's quite technical, but I thought it might be something you'd like to review, and it might be useful as a reference for forum discussions. The poster does mention that, in the general population, natural variations in the skull account for about 60 percent of skull lesions (at least that's my interpretation of a statement at the beginning of the poster).
I hope that the extra imaging that you'll be having done shows that the skull lesion isn't myeloma-related. Please keep us updated on what you find out.
Sorry to hear that you may have a lesion in your skull. I could understand how that, combined with the discussion you had with your doctor, could be causing you a lot of concern.
Before you jump to conclusions, one thing you should know is that the skull is an area of the body where x-rays often show what look like lytic lesions, but the lesions are not actually myeloma-related. Instead, they are what are known as "venous lakes".
I had never heard about this until I started reading postings here in the forum. Dr. Shain, one of the myeloma specialists who helps out here in the forum, describes how venous lakes are sometimes misdiagnosed as lytic lesions in this posting.
I also found this poster presentation that discusses skull lytic lesions and venous lakes. It's quite technical, but I thought it might be something you'd like to review, and it might be useful as a reference for forum discussions. The poster does mention that, in the general population, natural variations in the skull account for about 60 percent of skull lesions (at least that's my interpretation of a statement at the beginning of the poster).
I hope that the extra imaging that you'll be having done shows that the skull lesion isn't myeloma-related. Please keep us updated on what you find out.
Re: New here - IgG M-spike with low IgG; is that possible?
Ralph,
Ian brings up some good points. It's also worth having a second radiologist look at any results. When I was first diagnosed, the radiologist examining my xrays stated that I had lytic lesions. Yet, when I had two different radiologists look at the same image, they couldn't find any. I then had a PET/CT, which confirmed that my skeleton was "clean".
When I told one of my specialists about this, he stated that he has seen this happen quite a bit before (and is therefore not a fan of routine image screening without a good reason). The specialist stated that a radiologist will see the imaging order and a suspected diagnosis of multiple myeloma on that order, and then finds lytic lesions when they may in fact be something else.
It's good you are getting some follow up imaging using a different modality. Best of luck to you.
Ian brings up some good points. It's also worth having a second radiologist look at any results. When I was first diagnosed, the radiologist examining my xrays stated that I had lytic lesions. Yet, when I had two different radiologists look at the same image, they couldn't find any. I then had a PET/CT, which confirmed that my skeleton was "clean".
When I told one of my specialists about this, he stated that he has seen this happen quite a bit before (and is therefore not a fan of routine image screening without a good reason). The specialist stated that a radiologist will see the imaging order and a suspected diagnosis of multiple myeloma on that order, and then finds lytic lesions when they may in fact be something else.
It's good you are getting some follow up imaging using a different modality. Best of luck to you.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
7 posts
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