Thanks very much for your response! I really appreciate your insight. I had read from several online sources that any amount of globulin present in a 24-hour urine electrophoresis was abnormal. Some of the sources saying this are linked below:
"Protein electrophoresis is performed on urine samples to classify disorders that cause protein loss via the kidneys. In urine, normally no globulins and less than 0.050 g/dL albumin are present." - "Protein electrophoresis" entry at encyclopedia.com
"Interpreting the test results for UPEP is fairly straightforward. Globulins should not be present in your urine. Albumin levels should be below 5 milligrams per deciliter (mg/dL). Any amount of globulins or more than 5 mg/dL of albumin will be considered abnormal."
- "Protein Electrophoresis Urinalysis" entry at healthline.com
However, I spoke to my GP this morning and he didn't seem to think these statements were true and he thought all was ok. I am probably going to request the serum free light chain test when I see my hematologist in a month, but for now I will be taking your advice and chilling out a bit.
Thanks very much once again!
Forums
Re: No protein in urine, normal CBC & globulin - all clear?
Hello again everyone, I hope you're all doing well.
If you will recall from my earlier posts, I am in the process of evaluation for MGUS / multiple myeloma / amyloidosis, etc. Up until recently my results had all indicated no monoclonal proteins (negative serum electrophoresis, negative serum immunofixation, negative urine electrophoresis), and the only abnormalities discovered were a very slightly low total IgG and a very slightly elevated total IgA. I was feeling pretty optimistic because of these results, but then just yesterday I got results back for my serum free light chain assay, which showed the following:
Free Kappa Lt Chains,S: 8.77 mg/L (3.30 - 19.40)
Free Lambda Lt Chains,S: 3.80 mg/L Low (5.71 - 26.30)
Kappa/Lambda Ratio,S: 2.31 High (0.26 - 1.65)
According to the little chart that accompanies the test on the LabCorp website, a normal kappa, low lambda, and high ratio indicates some kind of monoclonal gammopathy with bone marrow suppression. I spoke to my doctor (GP, not hematologist yet) and he said he actually thought it was UNLIKELY to represent a monoclonal protein disorder since my ratio was only off because the lambda was actually low. Also, I should note that my CBC has been consistently normal, so wouldn't that point away from bone marrow suppression?
Another medical professional I consulted with told me that I would need to get a urine immunofixation test as well, because if it was normal then it would somehow negate the abnormality on the free light chain results. I have no idea how or why that would be the case and it seems contrary to the things I've read online, so any information on this would be greatly appreciated. (UPDATE 6/19) Well, I just got results back from immunofixation of a 24 hour sample and it was negative for monoclonal protein.
Is there any chance that this could be ok, or would the free light chain results almost certainly point to MGUS, multiple myeloma, or amyloidosis? I've scoured these forums looking for posts in which people not on treatment have had similar results, and without exception they have left the forum without updating as to whether or not they wound up with a diagnosis. Any information on my results would be HUGELY appreciated!
Thanks so very much!
If you will recall from my earlier posts, I am in the process of evaluation for MGUS / multiple myeloma / amyloidosis, etc. Up until recently my results had all indicated no monoclonal proteins (negative serum electrophoresis, negative serum immunofixation, negative urine electrophoresis), and the only abnormalities discovered were a very slightly low total IgG and a very slightly elevated total IgA. I was feeling pretty optimistic because of these results, but then just yesterday I got results back for my serum free light chain assay, which showed the following:
Free Kappa Lt Chains,S: 8.77 mg/L (3.30 - 19.40)
Free Lambda Lt Chains,S: 3.80 mg/L Low (5.71 - 26.30)
Kappa/Lambda Ratio,S: 2.31 High (0.26 - 1.65)
According to the little chart that accompanies the test on the LabCorp website, a normal kappa, low lambda, and high ratio indicates some kind of monoclonal gammopathy with bone marrow suppression. I spoke to my doctor (GP, not hematologist yet) and he said he actually thought it was UNLIKELY to represent a monoclonal protein disorder since my ratio was only off because the lambda was actually low. Also, I should note that my CBC has been consistently normal, so wouldn't that point away from bone marrow suppression?
Another medical professional I consulted with told me that I would need to get a urine immunofixation test as well, because if it was normal then it would somehow negate the abnormality on the free light chain results. I have no idea how or why that would be the case and it seems contrary to the things I've read online, so any information on this would be greatly appreciated. (UPDATE 6/19) Well, I just got results back from immunofixation of a 24 hour sample and it was negative for monoclonal protein.
Is there any chance that this could be ok, or would the free light chain results almost certainly point to MGUS, multiple myeloma, or amyloidosis? I've scoured these forums looking for posts in which people not on treatment have had similar results, and without exception they have left the forum without updating as to whether or not they wound up with a diagnosis. Any information on my results would be HUGELY appreciated!
Thanks so very much!
Re: No protein in urine, normal CBC & globulin - all clear?
Update:
I had an appointment with a hematologist today, and she was unable to explain my serum free light chain results. So it seems I'm no closer to getting to the bottom of this.
Does anyone have any experience with results similar to those in my above post (i.e., normal kappa, low lambda, high ratio)?
Thank you in advance for any information you might be able to provide!
I had an appointment with a hematologist today, and she was unable to explain my serum free light chain results. So it seems I'm no closer to getting to the bottom of this.
Does anyone have any experience with results similar to those in my above post (i.e., normal kappa, low lambda, high ratio)?
Thank you in advance for any information you might be able to provide!
Re: No protein in urine, normal CBC & globulin - all clear?
Hi all,
It's been a few months since I posted a question on here, but a quick recap of my situation is that I was being referred to a hem/onc as a result of a constellation of symptoms (coagulation problems, peripheral neuropathy, back pain, etc.) that were in keeping with a plasma cell dyscrasia, along with an elevated kappa/lambda ratio (2.75) on the serum free light chain test (Note: the ratio was high due to low lambda; the kappa was actually right in the middle of the reference range), as well as mildly elevated IgA and mildly decreased IgG.
All other tests were normal / showed no evidence of monoclonality (serum and 24-hour urine electro and immunofixation).
Anyhow, my hematologist / oncologist recommended a bone marrow biopsy on suspicion of possible AL amyloidosis, light chain deposition disease, or light chain myeloma. I was told that if it was normal I would probably have to have an additional fat pad biopsy and biopsy of my nerves to rule out amyloidosis.
However, once the results came in, the doctor told me that actually he didn't think further biopsies were necessary, and that my odds of having a problem were very very low.
This surprised me since bone marrow biopsies are apparently not super sensitive for amyloidosis or light chain deposition disease.
I'll post my results below, but can someone knowledgeable on these matters possibly tell me what, if anything, about my biopsy results would justify not doing further testing? Or should I get a second opinion?
Biopsy report findings below:
Diagnosis:
Bone marrow, site not specified, core biopsy and aspiration
- Normocellular bone marrow with morphologically normal trilineage and hematopoiesis
- No evidence of plasmacytosis
- No evidence of amyloidosis
Microscopic description:
The core biopsy is very good and the aspirate clot preparation contains additional marrow particles for evaluation. The marrow is 50-60% cellular. The myeloid:erythroid ratio is 3:1 and megakaryocytes are normal in number. All three lineages are morphologically unremarkable with no overt dyspoiesis. Lymphocytes and plasma cells are normal in number, distribution, and morphology. Atypical lymphoid aggregates or infiltrates are not identified. CD138 immunostain highlights a few scattered plasma cells (approximately 4%). Congo red special stain shows no evidence of amyloid deposition. A Prussian blue stain performed on the aspirate clot shows adequate storage iron without ring sideroblasts.
Aspirate smears:
The aspirate smears are cellular with spicules. All three lineages are morphologically unremarkable, with no overt dyspoiesis or excess blasts. Lymphocytes and plasma cells are normal in number, distribution and morphology. A prussian blue stain performed on the aspirate smear shows adequate storage iron without ring sideroblasts
200 cell manual differential count (%)
Blast: 1
Myeloid precursors: 62
Erythroid precursors: 22
Eosinophils: 3
Monocytes: 4
Lymphocytes: 6
Plasma cells: 2
Karyotyping analysis is pending and the results will be reported in an addendum (Note: I was not given a copy of this, so I don't know what it says).
It's been a few months since I posted a question on here, but a quick recap of my situation is that I was being referred to a hem/onc as a result of a constellation of symptoms (coagulation problems, peripheral neuropathy, back pain, etc.) that were in keeping with a plasma cell dyscrasia, along with an elevated kappa/lambda ratio (2.75) on the serum free light chain test (Note: the ratio was high due to low lambda; the kappa was actually right in the middle of the reference range), as well as mildly elevated IgA and mildly decreased IgG.
All other tests were normal / showed no evidence of monoclonality (serum and 24-hour urine electro and immunofixation).
Anyhow, my hematologist / oncologist recommended a bone marrow biopsy on suspicion of possible AL amyloidosis, light chain deposition disease, or light chain myeloma. I was told that if it was normal I would probably have to have an additional fat pad biopsy and biopsy of my nerves to rule out amyloidosis.
However, once the results came in, the doctor told me that actually he didn't think further biopsies were necessary, and that my odds of having a problem were very very low.
This surprised me since bone marrow biopsies are apparently not super sensitive for amyloidosis or light chain deposition disease.
I'll post my results below, but can someone knowledgeable on these matters possibly tell me what, if anything, about my biopsy results would justify not doing further testing? Or should I get a second opinion?
Biopsy report findings below:
Diagnosis:
Bone marrow, site not specified, core biopsy and aspiration
- Normocellular bone marrow with morphologically normal trilineage and hematopoiesis
- No evidence of plasmacytosis
- No evidence of amyloidosis
Microscopic description:
The core biopsy is very good and the aspirate clot preparation contains additional marrow particles for evaluation. The marrow is 50-60% cellular. The myeloid:erythroid ratio is 3:1 and megakaryocytes are normal in number. All three lineages are morphologically unremarkable with no overt dyspoiesis. Lymphocytes and plasma cells are normal in number, distribution, and morphology. Atypical lymphoid aggregates or infiltrates are not identified. CD138 immunostain highlights a few scattered plasma cells (approximately 4%). Congo red special stain shows no evidence of amyloid deposition. A Prussian blue stain performed on the aspirate clot shows adequate storage iron without ring sideroblasts.
Aspirate smears:
The aspirate smears are cellular with spicules. All three lineages are morphologically unremarkable, with no overt dyspoiesis or excess blasts. Lymphocytes and plasma cells are normal in number, distribution and morphology. A prussian blue stain performed on the aspirate smear shows adequate storage iron without ring sideroblasts
200 cell manual differential count (%)
Blast: 1
Myeloid precursors: 62
Erythroid precursors: 22
Eosinophils: 3
Monocytes: 4
Lymphocytes: 6
Plasma cells: 2
Karyotyping analysis is pending and the results will be reported in an addendum (Note: I was not given a copy of this, so I don't know what it says).
Re: No protein in urine, normal CBC & globulin - all clear?
In addition to the bone marrow biopsy results listed above, my hematologist / oncologist told me today that my serum LDH was actually low. He said this was a tumor marker and that he had never seen it lower than the reference range before. Any idea what this means?
Re: No protein in urine, normal CBC & globulin - all clear?
A quick Internet search suggests that low LDH can occur for genetic reasons and also as the result of high vitamin C intake. I did not see anything that suggests that a low LDH level is cause for alarm.
Re: No protein in urine, normal CBC & globulin - all clear?
Thanks very much for your response. Frankly I was a bit afraid to google what a low value on LDH would mean, since a hematologist telling you that he's never seen something before seems like it's probably a bad thing. Good to know that's apparently not the case!
Would you happen to have any insight into my question above regarding my bone marrow biopsy results? Thanks!
Would you happen to have any insight into my question above regarding my bone marrow biopsy results? Thanks!
Re: No protein in urine, normal CBC & globulin - all clear?
btdyq5,
I'm not a doc, so please verify this with one. But looking at all your test results together (including your bone marrow biopsy results) suggests to me that you are not dealing with a plasma cell disorder. I might simply suggest getting re-tested in 6 or so months just to put things completely to rest. As my specialist likes to say "if you don’t like your labs, just repeat them...you’ll like them better a second time."
Regarding a low LDH level, see:
https://labtestsonline.org/understanding/analytes/ldh/tab/test/
"Low and normal levels of LD do not usually indicate a problem. Low levels are sometimes seen when someone ingests large amounts of ascorbic acid (vitamin C)."
I'm not a doc, so please verify this with one. But looking at all your test results together (including your bone marrow biopsy results) suggests to me that you are not dealing with a plasma cell disorder. I might simply suggest getting re-tested in 6 or so months just to put things completely to rest. As my specialist likes to say "if you don’t like your labs, just repeat them...you’ll like them better a second time."
Regarding a low LDH level, see:
https://labtestsonline.org/understanding/analytes/ldh/tab/test/
"Low and normal levels of LD do not usually indicate a problem. Low levels are sometimes seen when someone ingests large amounts of ascorbic acid (vitamin C)."
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: No protein in urine, normal CBC & globulin - all clear?
Thanks Multibilly. Maybe you should be a doc, because you consistently seem to anticipate the exact thoughts of my doctor lol. He also recommended simply re-running labs in a few months.
Obviously I'm very happy to hear that my situation doesn't require more aggressive workup from my doc's perspective, but I do wish he (or someone) could explain to me what it is about my bone marrow biopsy that decreases suspicion of amyloidosis so strongly, because prior to the procedure he told me very specifically that the biopsy is relatively insensitive for detecting amyloidosis and further biopsies would be needed if the bone marrow biopsy came out clean. Obviously it did come out clean, but then he changed his tune and said no further biopsies needed, with no real explanation. Is there something in that report that somehow actively points away from or rules out amyloidosis, or is it just that the biopsy didn't find amyloid tissue itself?
Obviously I'm no expert in this stuff, so Multibilly if you have any insight it would be very much appreciated! My friends and family who have seen how many physical problems I've cultivated over the past year are all demanding that I push harder for more biopsies and I feel that if I understood my doc's reasoning a bit better I might be able to calm the troops a bit haha.
Obviously I'm very happy to hear that my situation doesn't require more aggressive workup from my doc's perspective, but I do wish he (or someone) could explain to me what it is about my bone marrow biopsy that decreases suspicion of amyloidosis so strongly, because prior to the procedure he told me very specifically that the biopsy is relatively insensitive for detecting amyloidosis and further biopsies would be needed if the bone marrow biopsy came out clean. Obviously it did come out clean, but then he changed his tune and said no further biopsies needed, with no real explanation. Is there something in that report that somehow actively points away from or rules out amyloidosis, or is it just that the biopsy didn't find amyloid tissue itself?
Obviously I'm no expert in this stuff, so Multibilly if you have any insight it would be very much appreciated! My friends and family who have seen how many physical problems I've cultivated over the past year are all demanding that I push harder for more biopsies and I feel that if I understood my doc's reasoning a bit better I might be able to calm the troops a bit haha.
Re: No protein in urine, normal CBC & globulin - all clear?
Well, maybe I missed it, but are you exhibiting any specific symptoms of having amyloidosis that would warrant additional testing? I also recall that your 24-hour urine test also came back clean (amyloidosis often causes raised protein levels in one's urine, since it often affects one's kidneys).
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
23 posts
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