My wife was diagnosed with Lambda IgG SMM last August. The labs done in October showed that her M-Spike was 3.15, HGB 11.4 and haptoglobin < 6. This week's tests showed that her M-Spike has dropped to 2.5, but with HGB further down to 9.9 and haptoglobin remained below 6. In addition, her B2M and LDH are also moving in the right direction and both are now in their normal range.
If M-Spike is indicative of the disease load, its lowering is a sign of improvement. My wife has been using curcumin during the period, which may or may not have made a difference. But the dipping trend of HGB seems to represent something opposite. Could there be a possibility that something other than myeloma is the other, or additional, reason for the worsening anemia? The reason for the suspicion is her low haptoglobin, which indicates the premature death of RBC's. I searched on the Internet for the relationship between haptoglobin and myeloma but there was not much to be seen.
Does anyone else have a similar experience? If the anemia keeps its downward movement, it is conceivable that my wife may need treatment soon. But I would want to make sure that myeloma is indeed the underlying source of her anemia before she is treated, together with all the side effects.
Another observation is her SPEP Albumin number seems to be always higher than her CBC Albumin number. Which one is more accurate?
Many thanks to everyone!
Forums
7 posts
• Page 1 of 1
Re: Low Haptoglobin and Myeloma
I can comment on your second question, regarding the SPEP versus CBC albumin number -- as explained to me by the oncologist.
The CBC value is more accurate, as it is a DIRECT measurement from the blood sample.
In contrast, the the SPEP value for for albumin (as well as the different globulin factions and the M-spike) is INDIRECT. It is based on two things: (1) the total amount of protein in the blood; and (2) the RELATIVE ratio of the peaks in the SPEP.
So if on a given day, transient levels of protein are high in the blood - -and that measurement is direct -- it will translate to relatively higher amounts of SPEP albumin, alpha, beta, and gamma globulin, and the M-spike.
This is also why the sum of all the peaks from the SPEP will equal the total amount of protein. It is not a coincidence.
The CBC value is more accurate, as it is a DIRECT measurement from the blood sample.
In contrast, the the SPEP value for for albumin (as well as the different globulin factions and the M-spike) is INDIRECT. It is based on two things: (1) the total amount of protein in the blood; and (2) the RELATIVE ratio of the peaks in the SPEP.
So if on a given day, transient levels of protein are high in the blood - -and that measurement is direct -- it will translate to relatively higher amounts of SPEP albumin, alpha, beta, and gamma globulin, and the M-spike.
This is also why the sum of all the peaks from the SPEP will equal the total amount of protein. It is not a coincidence.
-
Dan D
Re: Low Haptoglobin and Myeloma
Greetings from Seattle Ben S,
A low haptoglobin generally indicates destruction of red blod cells from hemolytic anemia. Myeloma does not cause hemolytic anemia. The cause of the anemia and low haptoglobin needs to be further evaluated. There are good treatments for hemolytic anemia and without treatment it can be life threatening. Other causes of a low haptoglobin include poor liver function, inherited causes and heart valve problems. The anemia is moderate to severe already at a hemoglobin of 9.9. This level of anemia meets the CRAB criteria for needing treatment. But if the anemia is from something else (hemolytic anemia) then the SMM/myeloma does not need to be treated but the hemolytic anemia does. These are important questiions for your HemeOnc doctor to sort out and answer.
Best of luck with this !
A low haptoglobin generally indicates destruction of red blod cells from hemolytic anemia. Myeloma does not cause hemolytic anemia. The cause of the anemia and low haptoglobin needs to be further evaluated. There are good treatments for hemolytic anemia and without treatment it can be life threatening. Other causes of a low haptoglobin include poor liver function, inherited causes and heart valve problems. The anemia is moderate to severe already at a hemoglobin of 9.9. This level of anemia meets the CRAB criteria for needing treatment. But if the anemia is from something else (hemolytic anemia) then the SMM/myeloma does not need to be treated but the hemolytic anemia does. These are important questiions for your HemeOnc doctor to sort out and answer.
Best of luck with this !
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Low Haptoglobin and Myeloma
Dr. Libby:
Thanks for responding to my questions. Is hemolytic anemia a special type of anemia? What are the differences between it and the "regular" type of anemia? Is it possible that my wife's myeloma has led to the incorrect reading of haptoglobin?
The reason I am asking this is my wife's doctors didn't seem to take the condition very seriously. When the low haptoglobin number was first discovered in August, and then repeated in October, no action was taken to further investigate the condition. Now that the time for treatment might be approaching, we feel the urgency to find out the actual cause of the anemia.
What tests would normally be the follow-up when low haptoglobin is identified? Do you have any suggestions on what questions we should ask when we meet the doctor?
Thanks again!
Ben
Thanks for responding to my questions. Is hemolytic anemia a special type of anemia? What are the differences between it and the "regular" type of anemia? Is it possible that my wife's myeloma has led to the incorrect reading of haptoglobin?
The reason I am asking this is my wife's doctors didn't seem to take the condition very seriously. When the low haptoglobin number was first discovered in August, and then repeated in October, no action was taken to further investigate the condition. Now that the time for treatment might be approaching, we feel the urgency to find out the actual cause of the anemia.
What tests would normally be the follow-up when low haptoglobin is identified? Do you have any suggestions on what questions we should ask when we meet the doctor?
Thanks again!
Ben
-
Ben S.
Re: Low Haptoglobin and Myeloma
Hi Ben S,
Wikipedia has a rather extensive article about hemolytic anemia. Here's the link:
http://en.wikipedia.org/wiki/Hemolytic_anemia
I've also included a few key excerpts below that might answer some of you main questions.
Good luck to you and your wife.
Excerpts from Wikipedia Article:
Hemolytic anemia (or haemolytic anaemia) is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). It has numerous possible causes, ranging from relatively harmless to life-threatening. The general classification of hemolytic anemia is either inherited or acquired. Treatment depends on the cause and nature of the breakdown.
Symptoms of hemolytic anemia are similar to other forms of anemia (fatigue and shortness of breath), but in addition, the breakdown of red cells leads to jaundice and increases the risk of particular long-term complications, such as gallstones and pulmonary hypertension.
Basic features
Hemolytic anemia involves the following:
Abnormal and accelerated destruction of red cells and, in some anemias, their precursors
Increased breakdown of hemoglobin, which may result in:
- increased bilirubin level (mainly indirect-reacting) with jaundice
- increased fecal and urinary urobilinogen
- Hemoglobinanemia, methemalbuminemia, hemoglobinuria and hemosiderinuria (where there is significant intravascular hemolysis).
Bone marrow compensatory reaction:
- Erythroid hyperplasia with accelerated production of red cells, reflected by reticulocytosis, and slight macrocytosis in peripheral blood
- Expansion of bone marrow in infants and children with severe chronic hemolysis - changes in bone configuration visible on X-ray
The balance between red cell destruction and marrow compensation determines the severity of anemias.
Signs and symptoms
In general, signs of anemia (pallor, fatigue, shortness of breath, and potential for heart failure) are present. In small children, failure to thrive may occur in any form of anemia. Certain aspects of the medical history can suggest a cause for hemolysis, such as drugs, consumption of fava beans, the presence of prosthetic heart valve, or other medical illness.
Chronic hemolysis leads to an increased excretion of bilirubin into the biliary tract, which in turn may lead to gallstones. The continuous release of free hemoglobin has been linked with the development of pulmonary hypertension (increased pressure over the pulmonary artery); this, in turn, leads to episodes of syncope (fainting), chest pain, and progressive breathlessness. Pulmonary hypertension eventually causes right ventricular heart failure, the symptoms of which are peripheral edema (fluid accumulation in the skin of the legs) and ascites (fluid accumulation in the abdominal cavity).
Diagnosis
Peripheral blood smear microscopy:
- Fragments of the red blood cells ("schistocytes") can be present
- Some red blood cells may appear smaller and rounder than usual (spherocytes)
- Reticulocytes are present in elevated numbers. This may be overlooked if a special stain is not used.
The level of unconjugated bilirubin in the blood is elevated. This may lead to jaundice.
The level of lactate dehydrogenase (LDH) in the blood is elevated
Haptoglobin levels are decreased
If the direct Coombs test is positive, hemolysis is caused by an immune process.
Hemosiderin in the urine indicates chronic intravascular hemolysis. There is also urobilinogen in the urine.
Treatment
Definitive therapy depends on the cause:
Symptomatic treatment can be given by blood transfusion, if there is marked anemia.
In severe immune-related hemolytic anemia, steroid therapy is sometimes necessary.
Sometimes splenectomy can be helpful where extravascular hemolysis is predominant (i.e. most of the red blood cells are being removed by the spleen).
Wikipedia has a rather extensive article about hemolytic anemia. Here's the link:
http://en.wikipedia.org/wiki/Hemolytic_anemia
I've also included a few key excerpts below that might answer some of you main questions.
Good luck to you and your wife.
Excerpts from Wikipedia Article:
Hemolytic anemia (or haemolytic anaemia) is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). It has numerous possible causes, ranging from relatively harmless to life-threatening. The general classification of hemolytic anemia is either inherited or acquired. Treatment depends on the cause and nature of the breakdown.
Symptoms of hemolytic anemia are similar to other forms of anemia (fatigue and shortness of breath), but in addition, the breakdown of red cells leads to jaundice and increases the risk of particular long-term complications, such as gallstones and pulmonary hypertension.
Basic features
Hemolytic anemia involves the following:
Abnormal and accelerated destruction of red cells and, in some anemias, their precursors
Increased breakdown of hemoglobin, which may result in:
- increased bilirubin level (mainly indirect-reacting) with jaundice
- increased fecal and urinary urobilinogen
- Hemoglobinanemia, methemalbuminemia, hemoglobinuria and hemosiderinuria (where there is significant intravascular hemolysis).
Bone marrow compensatory reaction:
- Erythroid hyperplasia with accelerated production of red cells, reflected by reticulocytosis, and slight macrocytosis in peripheral blood
- Expansion of bone marrow in infants and children with severe chronic hemolysis - changes in bone configuration visible on X-ray
The balance between red cell destruction and marrow compensation determines the severity of anemias.
Signs and symptoms
In general, signs of anemia (pallor, fatigue, shortness of breath, and potential for heart failure) are present. In small children, failure to thrive may occur in any form of anemia. Certain aspects of the medical history can suggest a cause for hemolysis, such as drugs, consumption of fava beans, the presence of prosthetic heart valve, or other medical illness.
Chronic hemolysis leads to an increased excretion of bilirubin into the biliary tract, which in turn may lead to gallstones. The continuous release of free hemoglobin has been linked with the development of pulmonary hypertension (increased pressure over the pulmonary artery); this, in turn, leads to episodes of syncope (fainting), chest pain, and progressive breathlessness. Pulmonary hypertension eventually causes right ventricular heart failure, the symptoms of which are peripheral edema (fluid accumulation in the skin of the legs) and ascites (fluid accumulation in the abdominal cavity).
Diagnosis
Peripheral blood smear microscopy:
- Fragments of the red blood cells ("schistocytes") can be present
- Some red blood cells may appear smaller and rounder than usual (spherocytes)
- Reticulocytes are present in elevated numbers. This may be overlooked if a special stain is not used.
The level of unconjugated bilirubin in the blood is elevated. This may lead to jaundice.
The level of lactate dehydrogenase (LDH) in the blood is elevated
Haptoglobin levels are decreased
If the direct Coombs test is positive, hemolysis is caused by an immune process.
Hemosiderin in the urine indicates chronic intravascular hemolysis. There is also urobilinogen in the urine.
Treatment
Definitive therapy depends on the cause:
Symptomatic treatment can be given by blood transfusion, if there is marked anemia.
In severe immune-related hemolytic anemia, steroid therapy is sometimes necessary.
Sometimes splenectomy can be helpful where extravascular hemolysis is predominant (i.e. most of the red blood cells are being removed by the spleen).
-
JimNY
Re: Low Haptoglobin and Myeloma
Thanks, JimNY. After reading the diagnosis section of your excerpt, I went back to the labs that were done this week and found that her Reticulocyte Count, Total Bilirubin and LDH were all in their normal ranges, with the only exception of Haptoglobin which was low. Maybe that was the reason the doctors weren't concerned with the possibility of hemolytic anemia. However, it is still a mystery why her Haptoglobin Count was so low. That's one question we need to bring to her doctor during her next appointment. Many thanks again!
-
Ben S.
7 posts
• Page 1 of 1