What causes low free kappa light chains, low free lambda light chains and a high kappa/lambda ratio? I also have high c-reactive protein and high ALP.
What would cause this? Thanks in advance.
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Re: Low kappa & lambda light chains, high kappa/lambda ratio
Brittan,
Welcome to the forum.
Before I offer up a possible explanation, could you possibly provide a bit more information on why you had your free light chains tested in the first place?
Are you being tested for suspected multiple myeloma and have you also had a serum protein electrophoresis test and a serum immunofixation test?
Welcome to the forum.
Before I offer up a possible explanation, could you possibly provide a bit more information on why you had your free light chains tested in the first place?
Are you being tested for suspected multiple myeloma and have you also had a serum protein electrophoresis test and a serum immunofixation test?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa & lambda light chains, high kappa/lambda ratio
Welcome, Brittan.
In addition to the very useful questions that Multibilly asked, the other one that I would ask is whether the results that you've described are from a blood (serum) free light chain test, or if they are from a urine free light chain test.
In addition to the very useful questions that Multibilly asked, the other one that I would ask is whether the results that you've described are from a blood (serum) free light chain test, or if they are from a urine free light chain test.
Re: Low kappa & lambda light chains, high kappa/lambda ratio
Nice catch Cheryl.
Brittan,
Also, the actual free light chain values (including the units of measure) would be helpful.
Brittan,
Also, the actual free light chain values (including the units of measure) would be helpful.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa & lambda light chains, high kappa/lambda ratio
Hello all! Thanks for the warm welcome.
The reason I had these test done was because my WBCwere high and so they were retested 3 months later and they were still high. So I was sent to a hematologist/oncologist.
The blood work that had me sent there is the following:
WBC count: 13.8 (High) - range: 3.8-10.8
Absolute Neutrophils: 8459 (H) - 1500-7800
Absolute Lymphocytes: 4030 (H) - 850-3900
Absolute Monocytes: 1035 (H) - 200-950
Alk. Phos: 136 (H) - 33-115
In another blood test taken these were other abnormal result:
MCH 31.1 (High) 27-31
Calculated Osmolity: 281 (Low)
Platelet: 430 (H) 150-400
RDW 11.4 (L) 11.5-14.5
And these are the tests I had done by the hem/oncologist:
Though Urine:
Free Kappa Lt Chains, Ur: 0.83 (Low) - 1.35-24.19
Free Lambda Lt Chain, Ur: 0.08 (Low) - 0.24-6.66
Kappa/Lambda Ratio, Ur: 10.38 (High) - 2.04-10.37
Other results in report:
Alk Phos: 122 (H) - 39-117
C-reactive Protein, Quant: 7,2 (H) - 0.0-4.9
In the Flow Cytometry Differential (% of Total Cells) -I got the following via blood (No range was included)
Lymphocytes 26
B-cells 2
Kappa 1.5
Lambda 0.8
Kappa:Lambda Ratio 1.9
T-cells 23
cd4 15.2
cd8 7.3
cd4:cd8 ratio 2.1
cd3+cd56+ <1
Natural Killer Cells 1
Monocytes: 4
Granulocytes 65
cd45 dim <1
Plasma cells <0.1
Viability 95
Any thoughts on any of this allow with Kappa and Lambda chains would be great . Thank you!
~Brittan
The reason I had these test done was because my WBCwere high and so they were retested 3 months later and they were still high. So I was sent to a hematologist/oncologist.
The blood work that had me sent there is the following:
WBC count: 13.8 (High) - range: 3.8-10.8
Absolute Neutrophils: 8459 (H) - 1500-7800
Absolute Lymphocytes: 4030 (H) - 850-3900
Absolute Monocytes: 1035 (H) - 200-950
Alk. Phos: 136 (H) - 33-115
In another blood test taken these were other abnormal result:
MCH 31.1 (High) 27-31
Calculated Osmolity: 281 (Low)
Platelet: 430 (H) 150-400
RDW 11.4 (L) 11.5-14.5
And these are the tests I had done by the hem/oncologist:
Though Urine:
Free Kappa Lt Chains, Ur: 0.83 (Low) - 1.35-24.19
Free Lambda Lt Chain, Ur: 0.08 (Low) - 0.24-6.66
Kappa/Lambda Ratio, Ur: 10.38 (High) - 2.04-10.37
Other results in report:
Alk Phos: 122 (H) - 39-117
C-reactive Protein, Quant: 7,2 (H) - 0.0-4.9
In the Flow Cytometry Differential (% of Total Cells) -I got the following via blood (No range was included)
Lymphocytes 26
B-cells 2
Kappa 1.5
Lambda 0.8
Kappa:Lambda Ratio 1.9
T-cells 23
cd4 15.2
cd8 7.3
cd4:cd8 ratio 2.1
cd3+cd56+ <1
Natural Killer Cells 1
Monocytes: 4
Granulocytes 65
cd45 dim <1
Plasma cells <0.1
Viability 95
Any thoughts on any of this allow with Kappa and Lambda chains would be great . Thank you!
~Brittan
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SmilesAlot - Name: Brittan
Re: Low kappa & lambda light chains, high kappa/lambda ratio
They did do a protein electrophoresis but it was not included with what I have. I'll have to call them to get it.
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SmilesAlot - Name: Brittan
Re: Low kappa & lambda light chains, high kappa/lambda ratio
Hmmm, I'm a little perplexed by these overall numbers, so I would really rely on your doc's opinion.
If you look at your metabolic panel test, is your total protein, creatinine or globulin level high?
If you look at your CBC test, is your hemogloblin level low?
Is your sodium level low since you have a low serum osmolality?
Were any other values flagged on your urine test results?
The free light chain numbers look like they came from a 24 hour urine test, right? See Dr. Hoffman's comments on the accuracy of free light chain measurements done with urine tests.
https://myelomabeacon.org/forum/kappa-lambda-ratio-blood-urine-t6120.html#p37400
If you had similar free light chain results with a serum free light chain test, then it could suggest a monoclonal gammopathy with bone marrow suppression. But again remember that urine free light chain numbers aren't that accurate and what I am suggesting here is from a guideline associated with SERUM free light chain values - so I wouldn't jump to this conclusion based on just these urine test results.
A few things such as the low osmolality, low RDW, high C-Reactive protein, high lymphocyte level and the the combo of your urine free light chain numbers would warrant doing a few more blood tests to rule out any sort of monoclonal gammopathy. The key tests would be a serum free light chain assay, serum immunofixation, quantified immunoglobulins and a serum protein electophoresis tests. But be clear that some of your numbers are not consistent with a monoclonal gammopathy.
In any case, your doc is the best person to comment on all this and guide you through the next steps.
Others on the forum may have some additional opinions.
If you look at your metabolic panel test, is your total protein, creatinine or globulin level high?
If you look at your CBC test, is your hemogloblin level low?
Is your sodium level low since you have a low serum osmolality?
Were any other values flagged on your urine test results?
The free light chain numbers look like they came from a 24 hour urine test, right? See Dr. Hoffman's comments on the accuracy of free light chain measurements done with urine tests.
https://myelomabeacon.org/forum/kappa-lambda-ratio-blood-urine-t6120.html#p37400
If you had similar free light chain results with a serum free light chain test, then it could suggest a monoclonal gammopathy with bone marrow suppression. But again remember that urine free light chain numbers aren't that accurate and what I am suggesting here is from a guideline associated with SERUM free light chain values - so I wouldn't jump to this conclusion based on just these urine test results.
A few things such as the low osmolality, low RDW, high C-Reactive protein, high lymphocyte level and the the combo of your urine free light chain numbers would warrant doing a few more blood tests to rule out any sort of monoclonal gammopathy. The key tests would be a serum free light chain assay, serum immunofixation, quantified immunoglobulins and a serum protein electophoresis tests. But be clear that some of your numbers are not consistent with a monoclonal gammopathy.
In any case, your doc is the best person to comment on all this and guide you through the next steps.
Others on the forum may have some additional opinions.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa & lambda light chains, high kappa/lambda ratio
With regards to sodium - I've been adding a little extra each day due to black outs. I am also hypoglycemic ... I can not get my blood sugar above 100. And normally I have a tachycardia and that is no more - my heart rate varies from 60-80 bpm vs my norm which is around 102 - don't know if this matters. I also normally have high bp due to all the pain I am in and lately (the last 6 months) that has become more normal.
total protein: 7.0 (6.1-8.1)
creatinine: 0.84 (0.50-1.10)
hemogloblin: 13.6 - (11.7-15.5)
sodium: 136 (135-146)
urine test results - had no other flags on the report but it only noted the kappa/lambda results and I also noticed it did state "IFE + Protein Electro, 24 hr Urine"
Protein, Total Urine: <4.0 - range 0.0-15.0
Prot, 24hr calculated <128.0 - 30.0-150.0
Albumin, U: 100.0
Alpha-1-Globulin, U: 0.0
Alpha-2-Globulin,U: ).00
Beta Globulin, U: 0.0
Gamma Globulin, U: 0.0
M-Spikes, %: Not Observed
Immunofixation Result, Urine: An apparent normal immunofixation pattern
Report Note: Protein electrophoresis scan will follow via computer or mail.
----End of report----
"The free light chain numbers look like they came from a 24 hour urine test, right?" ->Yes, correct.
Do you know is the "flow cytometry differential (% of total cells)" is the same as testing the blood levels for the kappa.lambda? If yes, then I would still be considered low based on the various website stating the values for the blood tests.
My oncologist said I did not have leukemia and did no further testing and released me from his care. Any suggestions as to what kind of doctor I should follow up with - with regards to these results?
Thanks for your help, I greatly appreciated.
total protein: 7.0 (6.1-8.1)
creatinine: 0.84 (0.50-1.10)
hemogloblin: 13.6 - (11.7-15.5)
sodium: 136 (135-146)
urine test results - had no other flags on the report but it only noted the kappa/lambda results and I also noticed it did state "IFE + Protein Electro, 24 hr Urine"
Protein, Total Urine: <4.0 - range 0.0-15.0
Prot, 24hr calculated <128.0 - 30.0-150.0
Albumin, U: 100.0
Alpha-1-Globulin, U: 0.0
Alpha-2-Globulin,U: ).00
Beta Globulin, U: 0.0
Gamma Globulin, U: 0.0
M-Spikes, %: Not Observed
Immunofixation Result, Urine: An apparent normal immunofixation pattern
Report Note: Protein electrophoresis scan will follow via computer or mail.
----End of report----
"The free light chain numbers look like they came from a 24 hour urine test, right?" ->Yes, correct.
Do you know is the "flow cytometry differential (% of total cells)" is the same as testing the blood levels for the kappa.lambda? If yes, then I would still be considered low based on the various website stating the values for the blood tests.
My oncologist said I did not have leukemia and did no further testing and released me from his care. Any suggestions as to what kind of doctor I should follow up with - with regards to these results?
Thanks for your help, I greatly appreciated.
-
SmilesAlot - Name: Brittan
Re: Low kappa & lambda light chains, high kappa/lambda ratio
Your pending serum protein electrophoresis test will help settle if a plasma cell disorder is in play or not. But your urine test suggests that you don't have any monoclonal protein (no M-spikes, normal fixation pattern, etc), so that would argue against having a plasma cell disorder. Also, the fact that your total protein level is normal also argues against a plasma cell disorder.
The lambda and kappa light chains as measured by flow cytometry of your peripheral blood is not the same measurement as a serum free light chain assay, which only measures free light chains (as opposed to measuring both free and bound light chains via flow cytometry).
I'm guessing that your specific peripheral blood flow cytometry test was run by your doctor to rule out leukemia. This kind of peripheral blood flow cytometry test is not generally used for initially diagnosing a plasma cell disorder such as multiple myeloma and it would be set up to look for different "cd" markers if it were being used to look for multiple myeloma.
When you say you have "pain", what kind of pain do you have? Conditions that can cause an elevated WBC count are listed here:
http://www.mayoclinic.org/symptoms/high-white-blood-cell-count/basics/causes/sym-20050611
Since the oncologist ruled out leukemia, a rheumatologist or neurologist might be able to address several of the remaining conditions on the list above. Another approach would be to seek out a large, skilled institution like the Mayo to have a team of specialists help get to the bottom of this. If you let us know what city you are in, folks on the forum could make some recommendations as to which institutions to seek out.
Others on the forum may have some additional ideas.
The lambda and kappa light chains as measured by flow cytometry of your peripheral blood is not the same measurement as a serum free light chain assay, which only measures free light chains (as opposed to measuring both free and bound light chains via flow cytometry).
I'm guessing that your specific peripheral blood flow cytometry test was run by your doctor to rule out leukemia. This kind of peripheral blood flow cytometry test is not generally used for initially diagnosing a plasma cell disorder such as multiple myeloma and it would be set up to look for different "cd" markers if it were being used to look for multiple myeloma.
When you say you have "pain", what kind of pain do you have? Conditions that can cause an elevated WBC count are listed here:
http://www.mayoclinic.org/symptoms/high-white-blood-cell-count/basics/causes/sym-20050611
Since the oncologist ruled out leukemia, a rheumatologist or neurologist might be able to address several of the remaining conditions on the list above. Another approach would be to seek out a large, skilled institution like the Mayo to have a team of specialists help get to the bottom of this. If you let us know what city you are in, folks on the forum could make some recommendations as to which institutions to seek out.
Others on the forum may have some additional ideas.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
9 posts
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