[TXmomof4]

Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Sat Mar 21, 2015 3:45 pm

I've had two blood draws over the last two months. Both came back with inverted albumin/globulin ratios [A/G ratio less than 1.0] and elevated globulins. In this most recent one, the globulins were even higher.

The prompt for this draw was sharp thoracic pain, especially at night.

I guess my question is: What now? I'm in a bit of a pickle because I can't take off any work to go to the doctor, since I am new and on probation. But I don't know of any way to see a doctor on the weekends, unless it's urgent care, and that's not optimal, obviously.

[Multibilly]

Re: Inverted A/G ratio, elevated globulins - next steps?

by Multibilly on Sat Mar 21, 2015 7:21 pm

Hi TxMomof4,

Welcome to the forum.

So, I take it that you don't currently have a diagnosis of multiple myeloma, but you think you might based on your elevated globulin level and thoracic pain, right?

Has the doctor that ordered your last two tests suggested further testing for multiple myeloma to you? You can just call his/her office and ask.

If the issue is that you can't get to a doctor's office on a weekday for follow-up lab testing, your doc could just call in an order for the basic follow-up multiple myeloma lab tests (IFE, SPEP, Freelite assay, quan­ti­fied im­muno­glob­u­lins, etc) at one of your local LabCorp or Quest Diag­nostics labs (whichever your insurance covers) that is open on a Saturday.

To see which labs are in your area and that might be open on a Saturday, see:

https://www.labcorp.com/wps/portal/findalab
https://secure.questdiagnostics.com/hcp/psc/jsp/SearchLocation.do?newSearch=FindLocation

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Sun Mar 22, 2015 3:14 pm

No, not diagnosed yet. I've been feeling off lately, and with the back pain and abdominal pain, I've been to the urgent care center twice in the last two months. That's what I've had the two blood draws. The doctor (actually, it was a PA both times...) told me both times that my labs were "totally normal" and he didn't see any cause for concern, yet I'm not getting better.

I work for the county here, and am in the middle of a 6 month probationary period, and work Mon through Fri 8-5. My PCP closes every day at 3:30. Even if she stayed open til 5, I still can't use any sick time because of the probationary period, so I've had to resort to urgent care when I'm not feeling well. I didn't think that would be an issue, but now it looks like it might.

Anyhow, I am faxing my labs to my PCP tomorrow, and will see if she can refer me somewhere I guess, but I'm still not going to be able to take any time off work to even go see a specialist. I feel pretty trapped right now, and have no idea how I'm supposed to get the care I need when I can't take off work, you know?

Who should I even be referred to, a hematologist? I just don't know where to start.

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Sun Mar 22, 2015 3:21 pm

I should note, that neither sets of my labs were "totally normal". I had highs and lows throughout, but he didn't feel like telling me that I guess. This is why I always get copies of my results.

[Multibilly]

Re: Inverted A/G ratio, elevated globulins - next steps?

by Multibilly on Sun Mar 22, 2015 5:47 pm

Hi TXmom,

I get the schedule dilemma you are in.

Again, given your situation, I might suggest just having your PCP call in the tests I mentioned to a LabCorp or Quest Diagnostics draw site and just go there to have the tests done on a Saturday (if one of them is open on a Saturday, which is pretty likely). Based on those additional lab results, a PCP or many folks on this forum can then tell you if something looks potentially suspicious for multiple myeloma.

If any of those follow-up test results do possibly suggest multiple myeloma, your PCP would almost certainly then refer you to a hematologist for follow up. If you let us know what city you are in, folks on this site can recommend specific hematologists and/or facilities to seek out that specialize in multiple myeloma.

In the meantime, some other things to check for in your current lab reports might be whether your calcium level is elevated on your comprehensive metabolic panel (CMP) test. You might also check if your creatinine or total protein levels are elevated on that same CMP test. Additionally, you should check if your hemoglobin (HGB) level may be low your CBC test (if you had that test done). These are not sure-fire indicators of multiple myeloma, but they "may" provide additional clues if any of these values are out of whack.

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Sun Mar 22, 2015 10:22 pm

Total protein is elevated, creatinine is low. Anion gap dropped from 15 to a 3 in 6 weeks' time. Not anemic. Normal calcium.

I'll ask my PCP to order further labs to nail down what's going on.

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Mon Mar 23, 2015 10:24 am

My doctor called in the following labs for me to go do today:

- Immunofixation + Protein Electrophoresis with Immunoglobulin, Quantitative
- Free Light Chains, Serum
- Beta-2-Microglobulin

Do those sound right?

[Multibilly]

Re: Inverted A/G ratio, elevated globulins - next steps?

by Multibilly on Mon Mar 23, 2015 1:14 pm

Hi TXmom,

These sound like a good round of tests to do at this point since your already did a CMP and CBC. Given you have already noted some elevated protein and globulin already in your blood serum, these should give you a pretty good idea if some form of multiple myeloma may be in play. Some docs might also suggest a 24 hr UPEP, but I'm not sure that would be absolutely required at this stage.

Please also note that this could very well may be something else altogether, so try not to fret in the meantime. Wishing you the best on your test results.

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Mon Mar 23, 2015 1:30 pm

Thanks for the response. I just got back from the draws, and they said I should have the results later this afternoon. Here's hoping it's in the category of "other" rather than multiple myeloma. Not something I desperately would like to go through, you know?

[TXmomof4]

Re: Inverted A/G ratio, elevated globulins - next steps?

by TXmomof4 on Mon Mar 23, 2015 2:17 pm

I haven't received all of the results back, but just got the CBC back. I've already had a general trend over the past several months of my lymphocytes decreasing, while my neutrophils in­creased. Today's draw showed my lymphocytes dropped 13 points, and my neuts increased 15. This is in a month's time.

Now I'm really starting to worry.