Hello everyone.
Thanks for having me. My name is Patti. I am 51 years old. I am a breast cancer survivor 5 years now.
I received a lab report back where multiple lab tests were done and under SPEP there is a comment that monoclonal protein detected and is required that I have a urine electrophoresis test to exclude light chain paraproteins.
These are the lab results below. I'm not sure how to tell what is a monoclonal protein. Can someone help me understand where it is?
SPEP
ALBUM 4.0
A-1Gg/ 0,2
A-2Gg/ 1.2
BeGlg/1.0
Gamgb/ 0.8
ELC - NO
MONOCLONAL PROTEIN DETECTED. URINE ELECTROPHORESIS REQUIRED TO EXCLUDE LIGHT CHAIN PARAPROTEIN.
There was also these labs that were elevated
PCV 44
CPKT 297
I'm a little worried. I am a breast cancer survivor, 5 years. I have been really sick these past few years. Mainly severe fatigue, bone pain so bad I'm in the doctor on a regular basis. I have osteopenia in pelvis, high risk fracture now, age 51.
Thank you all for any help.
Forums
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Re: Monoclonal protein detected?
Hi Patti,
Welcome to the forum. Do you know why your doctor ran an SPEP to begin with? Were you experiencing some symptoms that led him/her to order this test?
There are two kinds of monoclonal proteins that can potentially be found in the body if one has a monoclonal protein disorder - namely immunoglobulin heavy and light chains. SPEPs measure the amount of monoclonal immunoglobulin heavy chains in your blood (having no monoclonal proteins is what is normal). It looks like your SPEP may have detected the presence of a monoclonal heavy chain, but I am guessing that it was probably too small to actually measure, which is why no value for the monoclonal heavy chain (aka an "M-spike") was listed on the SPEP report. This may just be a passing phenomena, so I wouldn't fret about this just yet.
To be thorough and to exclude a light chain disorder (the "ELC" remark in your report), the pathologist that wrote up the report is recommending that you get a test to detect and measure any monoclonal free light chains (also known as free light chain paraproteins) in your body - namely a 24 hour urine protein electrophoresis (UPEP) test. As a follow up, I might suggest having your doctor run all of the following tests:
Serum immunofixation electrophoresis (IFE)
Serum protein electrophoresis (SPEP) (re-run this test)
Quantified immunoglobulins (IgG, IgA, IgM)
Serum free light chain assay
24-hour UPEP
On another note, your CPK looks a bit high. CPK measures muscle damage that could be due to heavy exercise, autoimmune diseases, or a heart attack. However, a high CPK can also be due to a low thyroid level or it can be a byproduct of taking certain meds, including some cholesterol meds. My CPK is also a bit high, but that is because I take a mix of cholesterol meds which is known to raise one's CPK. It would be good to discuss this further with your doc.
Welcome to the forum. Do you know why your doctor ran an SPEP to begin with? Were you experiencing some symptoms that led him/her to order this test?
There are two kinds of monoclonal proteins that can potentially be found in the body if one has a monoclonal protein disorder - namely immunoglobulin heavy and light chains. SPEPs measure the amount of monoclonal immunoglobulin heavy chains in your blood (having no monoclonal proteins is what is normal). It looks like your SPEP may have detected the presence of a monoclonal heavy chain, but I am guessing that it was probably too small to actually measure, which is why no value for the monoclonal heavy chain (aka an "M-spike") was listed on the SPEP report. This may just be a passing phenomena, so I wouldn't fret about this just yet.
To be thorough and to exclude a light chain disorder (the "ELC" remark in your report), the pathologist that wrote up the report is recommending that you get a test to detect and measure any monoclonal free light chains (also known as free light chain paraproteins) in your body - namely a 24 hour urine protein electrophoresis (UPEP) test. As a follow up, I might suggest having your doctor run all of the following tests:
Serum immunofixation electrophoresis (IFE)
Serum protein electrophoresis (SPEP) (re-run this test)
Quantified immunoglobulins (IgG, IgA, IgM)
Serum free light chain assay
24-hour UPEP
On another note, your CPK looks a bit high. CPK measures muscle damage that could be due to heavy exercise, autoimmune diseases, or a heart attack. However, a high CPK can also be due to a low thyroid level or it can be a byproduct of taking certain meds, including some cholesterol meds. My CPK is also a bit high, but that is because I take a mix of cholesterol meds which is known to raise one's CPK. It would be good to discuss this further with your doc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monoclonal protein detected?
Thank you for your help.
After my breast cancer in 2011, my radiation treatments triggered lupus and rheumatoid arthritis. When my radiation treatments were over, I was diagnosed with thyroid cancer. I have been sick ever since. No treatment is helping me at all.
I have been deteriorating ever since. I found these labs of the SPEP test results when organizing all of my files at home. This specific lab work was done in March of 2014. My rheumatologist ordered these and she never followed up on any of it. She called and said everything was normal. I have all of the copies and just happened to re read it the other day.
So, for over two years, this has been ticking away and I have been extremely sick with severe bone pain and fatigue so bad I can't even get through the grocery store anymore without feeling like I am going to collapse. I have been complaining of rib pain to my oncologist, bone pain, and to my rheumatologist I have had for the past two years. They do nothing for me and tell me to continue to take diclofenac (Voltaren). My oncologist prescribed me Fosamax (alendronic acid). That's it. No one has done any type of blood work to look into anything for me. One doctor laughed at me when I was crying. The one who called me and said everything was normal.
I found this lab report. And, last month, I had a urine chemistry and urinalysis done. On the urine chemistry, my creatinine was H at 185.75, my protein was H at 17, my Bil ua was H at a 2.
I have asked for a 24-hour urine for over a month now. They do a dip stick and say it's fine. I tell them that from the urine lab with the elevated creatinine and protein they were supposed to do a 24-hour. They are telling me that because the dip stick is normal they don't need to.
No one will listen to me. I lie in bed some nights and cry myself to sleep from the overwhelming exhaustion and pain. Now I'm wondering if all of this with the monoclonal protein detected, if it's all related somehow.
After my breast cancer in 2011, my radiation treatments triggered lupus and rheumatoid arthritis. When my radiation treatments were over, I was diagnosed with thyroid cancer. I have been sick ever since. No treatment is helping me at all.
I have been deteriorating ever since. I found these labs of the SPEP test results when organizing all of my files at home. This specific lab work was done in March of 2014. My rheumatologist ordered these and she never followed up on any of it. She called and said everything was normal. I have all of the copies and just happened to re read it the other day.
So, for over two years, this has been ticking away and I have been extremely sick with severe bone pain and fatigue so bad I can't even get through the grocery store anymore without feeling like I am going to collapse. I have been complaining of rib pain to my oncologist, bone pain, and to my rheumatologist I have had for the past two years. They do nothing for me and tell me to continue to take diclofenac (Voltaren). My oncologist prescribed me Fosamax (alendronic acid). That's it. No one has done any type of blood work to look into anything for me. One doctor laughed at me when I was crying. The one who called me and said everything was normal.
I found this lab report. And, last month, I had a urine chemistry and urinalysis done. On the urine chemistry, my creatinine was H at 185.75, my protein was H at 17, my Bil ua was H at a 2.
I have asked for a 24-hour urine for over a month now. They do a dip stick and say it's fine. I tell them that from the urine lab with the elevated creatinine and protein they were supposed to do a 24-hour. They are telling me that because the dip stick is normal they don't need to.
No one will listen to me. I lie in bed some nights and cry myself to sleep from the overwhelming exhaustion and pain. Now I'm wondering if all of this with the monoclonal protein detected, if it's all related somehow.
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mcewenp65 - Name: Patti
Re: Monoclonal protein detected?
Wow, this is just heartbreaking hearing how your doctors have treated you.
With your insurance plan, do you have the option to seek out a different specialist on your own? If so, I'd find a good hematologist/oncologist (we can suggest some nearby if you let us know what city your are in) and follow up with the tests I mentioned above. Given your urinalysis results (high creatinine and high protein), rib pain, fatigue and the fact that your SPEP detected a monoclonal protein back in 2014, it seems perfectly reasonable to me to rule out a plasma cell disorder via some very basic and inexpensive tests.
Lastly, you mention you have fatigue. How are your red blood cell (RBC) and hemoglobin levels doing?
With your insurance plan, do you have the option to seek out a different specialist on your own? If so, I'd find a good hematologist/oncologist (we can suggest some nearby if you let us know what city your are in) and follow up with the tests I mentioned above. Given your urinalysis results (high creatinine and high protein), rib pain, fatigue and the fact that your SPEP detected a monoclonal protein back in 2014, it seems perfectly reasonable to me to rule out a plasma cell disorder via some very basic and inexpensive tests.
Lastly, you mention you have fatigue. How are your red blood cell (RBC) and hemoglobin levels doing?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monoclonal protein detected?
Yes, I am seeing my oncologist / hematologist Tuesday of next week. This is the only place that takes the insurance I have. The doctor who laughed at me, and I did make a comment to her regarding her behavior back then, she is with a rheumatologist group at a hospital here in Nashville.
I'm praying that for these past two plus years since the M-protein was found that this hasn't given it time to turn into something because I was left untreated. I'm trying to understand the test. Which immunoglobulin is telling I have a monoclonal protein? How do I know if it was high or low? Which type? Heavy or light?
I'm praying that for these past two plus years since the M-protein was found that this hasn't given it time to turn into something because I was left untreated. I'm trying to understand the test. Which immunoglobulin is telling I have a monoclonal protein? How do I know if it was high or low? Which type? Heavy or light?
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mcewenp65 - Name: Patti
Re: Monoclonal protein detected?
Let me try to explain this slightly differently. What I think your SPEP is telling you is that it detected a monoclonal heavy chain (which would be either of the IgG, IgA or IgM variety), but the amount of the monoclonal protein was too small for the SPEP to quantify (measure). Keep in mind that an SPEP test won't tell you the type of monoclonal heavy chain type it detected (IgG, IgA, or IgM), only that you might have a monoclonal heavy chain of some variety and it will measure it if it can.
Since the SPEP flagged the presence of a monoclonal heavy protein, but it didn't seem like it was able to actually measure it, it's reasonable to eliminate the possibility that you might have some monoclonal free light chains (either of the kappa or lambda variety). While most people with a plasma cell disorder such as multiple myeloma have both measurable amounts of monoclonal heavy and light chains (e.g. monoclonal IgG lambda, or IgA kappa, etc), about 20% of those folks only have measurable monoclonal light chains and no or extremely few monoclonal heavy chains in their blood. That's why it's important to follow through with the other tests I mentioned so that you can eliminate the possibility of a light-chain-only disorder (as suggested by the pathologist in 2014).
Usually, when one runs an SPEP, a serum immunofixation (IFE) test is also run, so you might want to go back and look for that test. The IFE tells you much more accurately if you have the presence of a monoclonal heavy chain, monoclonal free light chain, or both. And it will tell you what type those monoclonal immunoglobulins might be (kappa-only, IgG-lambda, etc). But the IFE won't actually measure those monoclonal light chain levels. That's where the serum free light chain assay and 24-hour urine test come into play.
Lastly, the IgG, IgA, IgM tests will tell you if any of these immunoglobulins are elevated (suggesting that you might possibly have monoclonal heavy chains in your system if one of these values is elevated), or it will tell you if one or more of these immunoglobulins might be suppressed, which can mean that your immune system is compromised somehow.
The bottom line is that you aren't going to be able to figure any of this out without some more tests.
Since the SPEP flagged the presence of a monoclonal heavy protein, but it didn't seem like it was able to actually measure it, it's reasonable to eliminate the possibility that you might have some monoclonal free light chains (either of the kappa or lambda variety). While most people with a plasma cell disorder such as multiple myeloma have both measurable amounts of monoclonal heavy and light chains (e.g. monoclonal IgG lambda, or IgA kappa, etc), about 20% of those folks only have measurable monoclonal light chains and no or extremely few monoclonal heavy chains in their blood. That's why it's important to follow through with the other tests I mentioned so that you can eliminate the possibility of a light-chain-only disorder (as suggested by the pathologist in 2014).
Usually, when one runs an SPEP, a serum immunofixation (IFE) test is also run, so you might want to go back and look for that test. The IFE tells you much more accurately if you have the presence of a monoclonal heavy chain, monoclonal free light chain, or both. And it will tell you what type those monoclonal immunoglobulins might be (kappa-only, IgG-lambda, etc). But the IFE won't actually measure those monoclonal light chain levels. That's where the serum free light chain assay and 24-hour urine test come into play.
Lastly, the IgG, IgA, IgM tests will tell you if any of these immunoglobulins are elevated (suggesting that you might possibly have monoclonal heavy chains in your system if one of these values is elevated), or it will tell you if one or more of these immunoglobulins might be suppressed, which can mean that your immune system is compromised somehow.
The bottom line is that you aren't going to be able to figure any of this out without some more tests.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monoclonal protein detected?
Multibilly,
Thank you. That was the most thorough explanation of heavy and/or light chain myeloma I have ever seen summarized. Being IgG lambda, I never understood when somebody classified their disease without both a heavy and light chain component. (Actually, I thought they were wrong or inaccurate by not including at least the heavy chain in their diagnosis.) Equally as helpful is the break down of SPEP and IFE tests and their usefulness.
Now if I can just remember this information, or where I read it, or save it where I can find it, or what kind of coffee is this (chemo brain).
Craig
Thank you. That was the most thorough explanation of heavy and/or light chain myeloma I have ever seen summarized. Being IgG lambda, I never understood when somebody classified their disease without both a heavy and light chain component. (Actually, I thought they were wrong or inaccurate by not including at least the heavy chain in their diagnosis.) Equally as helpful is the break down of SPEP and IFE tests and their usefulness.
Now if I can just remember this information, or where I read it, or save it where I can find it, or what kind of coffee is this (chemo brain).
Craig
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Monoclonal protein detected?
Thank you Multibilly. That was great information. I'm going to the oncologist today and taking all of the tests you recommended to compare with what he says he's going to do. I am pretty upset at the fact that no one did anything back in 2014 when the results appeared.. I should have paid more attention to the whole lab result, as the doctor who ordered it should have as well..
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mcewenp65 - Name: Patti
8 posts
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