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Low m protein, kappa FLC & FLC ratio; cause for concern?

by Davethepuzzled on Wed Mar 05, 2014 9:19 am

I have a small M protein, less than 1 gram. This was identified after a serious liver abscess and a workup that had a CRP of 167 and sed rate of 130. The liver abscess and resultant sepsis were attributed by I D to an ER CP 8 months previous. Immunofixation was done and its IgG kappa.

Anyway, its three months later and abscess is completely healed US. I feel fine and am exercising and back to work fulltime. My FLC analysis was normal values and normal ratio. Recent bloods showed completely normal comprehensive metabolic panel and CBC. CRP is less than 3 and SPEP shows, "no appreciable change in M protein, but kappa FLC is now low and lambda has fallen, but still in normal range. Ratio is now low."

Do you think my small M protein could be a result of the sepsis and liver abscess? Should I be worried about the ratio when the absolute numbers are low and normal respectively?

Thank you!

Davethepuzzled

Re: Low m protein, kappa FLC & FLC ratio; cause for concern?

by Dr. Jason Valent on Thu Mar 06, 2014 10:34 am

It is possible to have relative immune suppression leading to infections as a consequence of the M-protein. It is helpful to know what your quantitative immunoglobulins are. For instance with an M-protein of 1 and a total IgG level of 1800, that leaves 800 of the IgG that is normal and that should provide for relatively normal immune function. However if the IgG is 1300 with an M-protein of 1, then the "healthy" IgG is only 300 and may lead to impaired immune function.

The relatively low light chains may be an indication of some immune suppression.

With just the one infectious complication, I would not think intervention is necessary currently. I use supplemental IVIG for patients with frequent infections and low "healthy" IgG levels who do not meet other criteria for the start of multiple myeloma therapy.

I hope this was understandable. Probably worth discussing with your hematologist as well.

Dr. Jason Valent
Name: Jason Valent, M.D.
Beacon Medical Advisor


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