[rhkeiiy]

Low platelets level - does it mean multiple myeloma?

by rhkeiiy on Sun Nov 20, 2016 2:45 am

Hi everyone,

This is all totally new to me.

My primary doctor referred me to a hematologist/oncologist because she noted my platelets were low, although they've truly been on the low side for 10 years. I am asymptomatic.

I saw the hematologist/oncologist only once, on October 31st. I haven't seen him since. But, I got my lab results and visit notes online and am wondering what they could all mean.

My protein electrophoresis looks normal, calcium is good, BUN/creatinine look good. My vitamin B12 is elevated, however.

Do the results suggest I have multiple myeloma?

Here are all my most recent labs:

Kappa Fr Lt Chains 3.77 mg/dL
Lambda Fr Lt Chains 1.53 mg/dL
Kappa/Lambda Ratio 2.46

Protein, Serum 6.9 g/dL
Albumin grams/dl 4.08 g/dL
Alpha-1 grams/dl 0.27 g/dL
Alpha-2 grams/dl 0.62 g/dL
Beta grams/dl 0.91 g/dL
Gamma grams/dl 1.01 g/dL

Vitamin B-12 1464 pg/mL 210-950 pg/mL

Total Protein 6.7 g/dL
Albumin 3.6 g/dL 3.5 - 5.2 g/dL
Total Bilirubin 1.1 mg/dL
Bilirubin, Direct 0.4 mg/dL
AST 27 U/L
ALT 21 U/L
Alkaline Phosphatase 107 U/L

Sodium 143 mmol/L
Potassium 3.7 mmol/L
Chloride 108 mmol/L
CO2 24 mmol/L
Glucose 82 mg/dL
BUN, Bld 18 mg/dL
Creatinine 0.9 mg/dL
Calcium 9.1 mg/dL
Total Protein 6.6 g/dL
Albumin 3.7 g/dL
Total Bilirubin 1.2 mg/dL

WBC 6.74 K/uL
RBC 5.25 M/uL
Hemoglobin 14.8 g/dL
Hematocrit 42.9 %
MCV 82 fL
MCH 28.2 pg
MCHC 34.5 %
RDW 13.6 %
Platelets 123 K/uL
MPV 9.0 fL
Gran # 3.4 K/uL
Lymph # 2.5 K/uL
Mono # 0.6 K/uL
Eos # 0.3 K/uL
Baso # 0.03 K/uL
Gran% 49.9 %
Lymph% 36.5 %
Mono% 8.9 %
Eosinophil% 4.0 %
Basophil% 0.4 %
Differential Method Automated

ANA Screen Negative
DRVVT, Lupus Anticoagulant Negative
GGT 49 U/L

Visit notes:

60-year-old man referred for thrombocytopenia.

Review of his labs revealed he's had mild thrombo­cytopenia dating back to 2006. His platelet count have generally been mildly decreased in the 120-140,000 range with some counts in the low normal range. His most recent blood work from August and September 2016 showed a platelet count of 122 and 123,000. His previous CBC from October 2015 showed a platelet count 130,000.

His white blood cell count and hemoglobin have remained stable throughout.

Abdominal imaging in 2015 showed no evidence of hepatic or splenic abnormalities.

Assessment: Thrombocytopenia

Plan: Mild chronic thrombocytopenia which could be immunologic origin. We'll rule out other causes. If those test are negative then no further workup is indicated."

Thank you very much!

[Multibilly]

Re: Low platelets level - does it mean multiple myeloma?

by Multibilly on Sun Nov 20, 2016 10:12 am

Did they run a serum immunofixation test? That's the key test that will tell you if your elevated kappa free light chain number is monoclonal (cancerous) in nature or not. Without knowing that, you really can't say if you might have a pre-cancerous condition such as MGUS or if your elevated kappa might be due to an infection or something else. In any case, nothing on your test results suggest full-blown myeloma. This article discusses some potential causes of low platelet counts:

http://www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/causes/con-20027170

[rhkeiiy]

Re: Low platelets level - does it mean multiple myeloma?

by rhkeiiy on Sun Nov 20, 2016 3:32 pm

Everything that they ordered so far I posted the results of.

Should I call and request a serum immunofixation test?

Thanks again!

[Multibilly]

Re: Low platelets level - does it mean multiple myeloma?

by Multibilly on Mon Nov 21, 2016 9:23 am

I would. Your serum free light chain values are only just slightly out of range, but it would be good to know if this is because of a monoclonal bump in your kappa that should be monitored from time to time.