Hi all,
I'm new to the forums, having just posted my first question last week. I am currently being referred to a hematologist for further testing following a diagnosis of type 1 von Willebrand's disease at age 31 and constant, low level petechiae for 7 months. This condition can be inherited (generally harmless) or acquired, due to multiple myeloma, MGUS, or Waldenstrom's macroglobulinemia.
Because of my age at diagnosis and relative lack of symptoms growing up, I'm concerned it could be due to one of the aforementioned conditions and I'm going to request that my hematologist test me for these. However, my appointment is over a month away and I had 2 quick questions that I was hoping might kind of steer toward or away from suspicion of these conditions.
1) If a routine urinalysis came back totally normal and negative for protein, would that in turn suggest that a urine electrophoresis would also most likely be normal?
Seems logical that if a urinalysis shows no protein at all/too little to detect that one could then assume that no abnormal proteins are present. However, I'm acutely aware that I have absolutely no experience with, nor clinical knowledge of this stuff and I could be 100% wrong. Thoughts?
2) I've had several CBCs and comprehensive metabolic panels over the past year, all of which have all come out perfectly normal. Now I just got back results today showing that my CBC is still fine (no anemia or anything), and once again everything was normal on the comprehensive metabolic panel. I realize that simply having a normal total protein level and a/g ratio does not rule out abnormal proteins in the blood, but would the fact that my total globulin level is only 2.3 (ref range: 1.5-4.5) decrease suspicion at all? With a value that low would there be "room" for monoclonal proteins?
Other potentially salient values are as follows:
Total protein: 7.4 (range 6.0-8.5)
Albumin: 5.1 (range 3.5-5.5)
Globulin: 2.3 (range 1.5 to 4.5)
A/G ratio: 2.2 (range 1.1 to 2.5)
Alk Phos: 64 (range 39-117)
Calcium: 9.7 (range 8.7-10.2)
- This one kind of worried me because it's not far from the top of the reference range, but I just checked my records and it's been at approximately that level since 2011.
Creatinine: 0.90 (range .76-1.27)
BUN: 19 (range 6-20)
- Borderline high, but I eat a high protein diet
eGFR: 113 (range >59)
Again, I realize that ultimately a diagnosis isn't going to be confirmed or refuted without the proper tests that I won't get for another month, but in the meantime does any of this seem reassuring or decrease suspicion of multiple myeloma, MGUS, or Waldenstrom's?
As I'm sure many on these forums can understand, a month of waiting just to BEGIN the diagnostic process is fairly anxiety-inducing, so I'm trying to find and hold onto any little peace of mind that I can get. Thank you all so much for reading, and thanks in advance for any information!
I will almost certainly be having numerous multiple / MGUS / Waldenstrom's blood and urine tests conducted at my hematologist appointment in one month, but for now I'm attempting to Thanks in advance for any info.
Forums
Re: No protein in urine, normal CBC & globulin - all clear?
From my experience you are in a good place. My diagnosis for Stage 1 multiple myeloma came about because of anemia found in a blood test. Confirmed by a runaway M protein spike. If I had your numbers, I'd be dancing a jig in the backyard!
However, look for the markers like a hungry bloodhound! The options are bewildering, so I focus on the M spike and light chain numbers.
A rising light chain number signalled a looming relapse for me recently. It is being treated through a trial. My take on the big C is find it early and respond to it as aggressively as allowed.
However, look for the markers like a hungry bloodhound! The options are bewildering, so I focus on the M spike and light chain numbers.
A rising light chain number signalled a looming relapse for me recently. It is being treated through a trial. My take on the big C is find it early and respond to it as aggressively as allowed.
-
Canuck Bob - Name: Bob
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb. 2011
- Age at diagnosis: 57
Re: No protein in urine, normal CBC & globulin - all clear?
HI,
I'm currently being evaluated for multiple myeloma, MGUS, and Waldenstrom macroglobulinemia.
I just received the following results and don't know how to interpret them. The electrophoresis came back clear, but the immunofixation came back abnormal. It says no monoclonality was detected, but my levels were out of range as follows. Please help me to understand.
Immunofixation, Serum (This is the one flagged as abnormal)
Immunofixation Result, Serum
No monoclonality detected. Ref Range
Immunoglobulin G, Qn, Serum 691 Low mg/dL 700 - 1600
Immunoglobulin A, Qn, Serum 400 High mg/dL 90 - 386
Immunoglobulin M, Qn, Serum 47 mg/dL 20 - 172
Protein Electro.,S Ref Range
Protein, Total, Serum 6.9 g/dL 6.0 - 8.5
Albumin 4.4 g/dL 3.2 - 5.6
Alpha-1-Globulin 0.2 g/dL 0.1 - 0.4
Alpha-2-Globulin 0.6 g/dL 0.4 - 1.2
Beta Globulin 1.0 g/dL 0.6 - 1.3
Gamma Globulin 0.7 g/dL 0.5 - 1.6
M-Spike Not Observed g/dL Not Observed
Globulin, Total 2.5 g/dL 2.0 - 4.5
A/G Ratio 1.8 0.7 - 2.0
I'm currently being evaluated for multiple myeloma, MGUS, and Waldenstrom macroglobulinemia.
I just received the following results and don't know how to interpret them. The electrophoresis came back clear, but the immunofixation came back abnormal. It says no monoclonality was detected, but my levels were out of range as follows. Please help me to understand.
Immunofixation, Serum (This is the one flagged as abnormal)
Immunofixation Result, Serum
No monoclonality detected. Ref Range
Immunoglobulin G, Qn, Serum 691 Low mg/dL 700 - 1600
Immunoglobulin A, Qn, Serum 400 High mg/dL 90 - 386
Immunoglobulin M, Qn, Serum 47 mg/dL 20 - 172
Protein Electro.,S Ref Range
Protein, Total, Serum 6.9 g/dL 6.0 - 8.5
Albumin 4.4 g/dL 3.2 - 5.6
Alpha-1-Globulin 0.2 g/dL 0.1 - 0.4
Alpha-2-Globulin 0.6 g/dL 0.4 - 1.2
Beta Globulin 1.0 g/dL 0.6 - 1.3
Gamma Globulin 0.7 g/dL 0.5 - 1.6
M-Spike Not Observed g/dL Not Observed
Globulin, Total 2.5 g/dL 2.0 - 4.5
A/G Ratio 1.8 0.7 - 2.0
Re: No protein in urine, normal CBC & globulin - all clear?
Hi btdyq5,
To be clear, your immunofixation result is the one that says that you have no detected monoclonality, which is good news.
Your electrophoresis test measured no M-spike – also good news.
Your quantified immunoglobulin test (the one that measures your IgA, IgG and IgM) is just slightly off. I don't know much about VWD, but I believe that your suppressed IgG level could be caused by VWD. Your IgA is just slightly elevated, but the rise must be "polyclonal" in nature due to your immunofixation results. An elevated polyclonal IgA reading could be due to something as simple as an infection (or perhaps VWD?). But only a doctor can make that call.
Did they also run a serum free light chain assay that measured your lambda and kappa free light chains?
I'm not a doc, but what you have posted so far doesn't suggest any sort of plasma cell disorder such as MGUS, multiple myeloma, or WM.
To be clear, your immunofixation result is the one that says that you have no detected monoclonality, which is good news.
Your electrophoresis test measured no M-spike – also good news.
Your quantified immunoglobulin test (the one that measures your IgA, IgG and IgM) is just slightly off. I don't know much about VWD, but I believe that your suppressed IgG level could be caused by VWD. Your IgA is just slightly elevated, but the rise must be "polyclonal" in nature due to your immunofixation results. An elevated polyclonal IgA reading could be due to something as simple as an infection (or perhaps VWD?). But only a doctor can make that call.
Did they also run a serum free light chain assay that measured your lambda and kappa free light chains?
I'm not a doc, but what you have posted so far doesn't suggest any sort of plasma cell disorder such as MGUS, multiple myeloma, or WM.
-
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?
Thank you so VERY much for your response! I was indeed very confused by the fact that my immunofixation was 'abnormal', but no monoclonal protein was detected. I thought the test was looking specifically for that. Newbie anxiety.
The free light chain testing has not been done at this point, but urine immunofixation results are currently pending (just turned in my 24-hour specimen earlier today). My testing situation is kind of unconventional because these tests were not actually ordered by my doctor. My hematologist appointment is not for the better part of a month, and my understanding is that the purpose of the appointment was to re-test von Willebrand parameters to confirm the diagnosis. Then if those results once again came back positive (I'm assuming they will), I was told that they *might* run the monoclonal protein tests a month later to look into possible causes of acquired von Willebrand's.
Being filled with anxiety and not exactly relishing the idea of a 2-month hold up, I decided to go a bit renegade and expedite the process by actually ordering the serum protein electrophoresis, serum immunofixation, and urine electrophoresis tests myself from an online company that partners with Lab Corp. I would have ordered the free light chain test but unfortunately it was not available for me to order.
Would it be fairly safe to say that if no monoclonal proteins are detected via serum electrophoresis / immunofixation AND urine electrophoresis that a monoclonal disorder is pretty well ruled out?
Thanks again so very much for your insight!
The free light chain testing has not been done at this point, but urine immunofixation results are currently pending (just turned in my 24-hour specimen earlier today). My testing situation is kind of unconventional because these tests were not actually ordered by my doctor. My hematologist appointment is not for the better part of a month, and my understanding is that the purpose of the appointment was to re-test von Willebrand parameters to confirm the diagnosis. Then if those results once again came back positive (I'm assuming they will), I was told that they *might* run the monoclonal protein tests a month later to look into possible causes of acquired von Willebrand's.
Being filled with anxiety and not exactly relishing the idea of a 2-month hold up, I decided to go a bit renegade and expedite the process by actually ordering the serum protein electrophoresis, serum immunofixation, and urine electrophoresis tests myself from an online company that partners with Lab Corp. I would have ordered the free light chain test but unfortunately it was not available for me to order.
Would it be fairly safe to say that if no monoclonal proteins are detected via serum electrophoresis / immunofixation AND urine electrophoresis that a monoclonal disorder is pretty well ruled out?
Thanks again so very much for your insight!
Re: No protein in urine, normal CBC & globulin - all clear?
I'm not a doc, but "pretty well ruled out" would be a fairly appropriate way to put it, especially since you have no symptoms and are only screening for a potential companion disease that can occur in some VWD patients. In any case, this would be a good thing for you to discuss with your hematologist.
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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?
Thank you Multibilly for your response!
One final question. I just got the following results back for my urine protein electrophoresis test and was wondering if someone could comment.
Value Result Reference Range
Protein, Total 6.3mg/dl Not established
Protein, 24 hour calculated 140.2 mg/24hr 30.0-150.0 mg/24 hours
Albumin, U 29.1% Not established
Alpha 1 Globulin, U 6.0% Not established
Alpha 2 Globulin, U 20.4% Not established
Beta Globulin, U 29.3% Not established
Gamma Globulin, U 15.1 Not established
M-Spike Not observed Not observed
Obviously I'm quite pleased to see that no M-Spike was present, but I am slightly concerned because I recently had a routine urinalysis that came up negative for protein, yet this test is showing that I'm nearly at the top of the reference range.
I know the kind of proteins that characterize myeloma are not necessarily picked up by a routine urinalysis test, so would the fact that my 24 hour protein is near the high end of the reference range signify that perhaps abnormal proteins are present, but just not detected as a spike?
I plan to ask my doctor to do the serum free chain testing as soon as possible, but in the meantime does any of this look ominous, given the previously negative routine urinalysis, or is this still in keeping with not having a monoclonal disorder?
Thanks so very much!
One final question. I just got the following results back for my urine protein electrophoresis test and was wondering if someone could comment.
Value Result Reference Range
Protein, Total 6.3mg/dl Not established
Protein, 24 hour calculated 140.2 mg/24hr 30.0-150.0 mg/24 hours
Albumin, U 29.1% Not established
Alpha 1 Globulin, U 6.0% Not established
Alpha 2 Globulin, U 20.4% Not established
Beta Globulin, U 29.3% Not established
Gamma Globulin, U 15.1 Not established
M-Spike Not observed Not observed
Obviously I'm quite pleased to see that no M-Spike was present, but I am slightly concerned because I recently had a routine urinalysis that came up negative for protein, yet this test is showing that I'm nearly at the top of the reference range.
I know the kind of proteins that characterize myeloma are not necessarily picked up by a routine urinalysis test, so would the fact that my 24 hour protein is near the high end of the reference range signify that perhaps abnormal proteins are present, but just not detected as a spike?
I plan to ask my doctor to do the serum free chain testing as soon as possible, but in the meantime does any of this look ominous, given the previously negative routine urinalysis, or is this still in keeping with not having a monoclonal disorder?
Thanks so very much!
Re: No protein in urine, normal CBC & globulin - all clear?
The immunofixation test is very sensitive at detecting monoclonal proteins (more so than the electrophoresis test). So, since your immunofixation test is negative, I wouldn't try to read anything into the electrophoresis test results with respect to "hidden" monoclonal proteins elevating your total protein count.
Also, since an immunofixation test will tell you if you have any monoclonal free light chains present and all your other tests look good, I would suggest being happy with your test results and simply assume for now that you don't have any sort of plasma cell disorder to worry about.
Also, since an immunofixation test will tell you if you have any monoclonal free light chains present and all your other tests look good, I would suggest being happy with your test results and simply assume for now that you don't have any sort of plasma cell disorder to worry about.
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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 very much for your reply and information.
When you say that the immunofixation is negative, do you mean the serum immunofixation that I had previously reported? Because I don't believe an immunofixation was done for my urine testing.
Also, and this is the part that freaked me out the most I suppose, I've read that the presence of ANY globulins in the urine is basically a harbinger of doom, and that the protein content of urine should be basically 100% albumin, whereas my protein content was only 29% albumin, with the remainder being divvied up between the various globulin types.
I suppose ultimately my question is whether the globulins found in my 24 hour urine electrophoresis are normal or are they Bence Jones proteins? Or would they only be Bence Jones proteins if an M-spike would have been observed?
Thank you!
When you say that the immunofixation is negative, do you mean the serum immunofixation that I had previously reported? Because I don't believe an immunofixation was done for my urine testing.
Also, and this is the part that freaked me out the most I suppose, I've read that the presence of ANY globulins in the urine is basically a harbinger of doom, and that the protein content of urine should be basically 100% albumin, whereas my protein content was only 29% albumin, with the remainder being divvied up between the various globulin types.
I suppose ultimately my question is whether the globulins found in my 24 hour urine electrophoresis are normal or are they Bence Jones proteins? Or would they only be Bence Jones proteins if an M-spike would have been observed?
Thank you!
Re: No protein in urine, normal CBC & globulin - all clear?
I think you might be overanalyzing this.
Your serum immunofixation stated:
Immunofixation Result, Serum
No monoclonality detected.
And you have no serum M-spike:
M-Spike Not observed Not observed
And you have no urine M-spike (aka Bence Jones proteins, aka monoclonal free light chains in your urine).
M-Spike Not observed Not observed
The above results are the key takeaways, IMHO.
My doctors don't' use UPEPs to monitor me, so I am not that familiar with UPEP test results. But I don't think it is accurate to say that any discovered protein in the urine should be 100% albumin and that having globulins in one's urine is the "harbinger of doom"? Where are you getting this information?
Again, I would suggest being happy with your test results and simply assume for now that you don't have any sort of plasma cell disorder to worry about ... and then discuss the results with your doctor.
Your serum immunofixation stated:
Immunofixation Result, Serum
No monoclonality detected.
And you have no serum M-spike:
M-Spike Not observed Not observed
And you have no urine M-spike (aka Bence Jones proteins, aka monoclonal free light chains in your urine).
M-Spike Not observed Not observed
The above results are the key takeaways, IMHO.
My doctors don't' use UPEPs to monitor me, so I am not that familiar with UPEP test results. But I don't think it is accurate to say that any discovered protein in the urine should be 100% albumin and that having globulins in one's urine is the "harbinger of doom"? Where are you getting this information?
Again, I would suggest being happy with your test results and simply assume for now that you don't have any sort of plasma cell disorder to worry about ... and then discuss the results with your doctor.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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