[pavgill]

Paraprotein found during gout diagnosis - meaning?

by pavgill on Sat Nov 07, 2015 8:10 am

Hi Guys,

I am new to this site – just joined today – and have found this site to be most useful.

I am hoping you can help me with some recent routine blood tests which have now led to me being referred to hematologist for further tests and appears they may suspect multiple myeloma Can someone please look at my blood results? Note these are in UK format and advice.

I initially undertook a blood test in early October to confirm a recent diagnosis of gout. Gout was indeed confirmed, but the blood test showed some other abnormal results as follows;

- Serum calcium level 2.73 mmol/l (2.2 -2.6 range)
- Serum total protein level 86 g/l (60-80 range)
- Serum globulin level 42 (25-41 range)
- Serum urate level 0.52 (0.2-0.42 range)
- Mean cell haemoglobin concentration 25.3 pg (27-32 range)

I was advised to re-take a blood test as my GP was a little concerned that both my calcium and protein levels had elevated levels. She was not too concerned with urate being increased as expected with gout neither with slightly low haemaglobin level especially as haemoglobin concentration was normal - 32.6 g/dl (30-35 range).

I retook the test on the 22nd October on the top 3 elevated levels. The new results had shown that pretty much all of the elevated levels were now back in "normal" range as follows;

- Serium calcium level 2.56 mmol/l (2.2 -2.6 range)
- Serum total protein level 81 g/l (60-80 range)
- Serum globulin level 39 g/l (25-41 range)

However my GP had also requested further tests with these blood tests and a few days ago she has advised an IgG kappa monoclonal protein (paraprotein) had been detected in my blood along with some abnormal "free light chain" results as follows;

Serum kappa light chain level 23.16 mg/l (3.3 -19.4)
Serum lambda light chain level 16.33 (5.7-26.3)
Kappa / lambda ratio 1.42 (0.26-1.65)

Immunoglobulin A level 1.99 g/l (0.8-3.0)
Immunoglobulin G level 16.12 g/l (5.4-16.1)
Immunoglobulin M level 0.58 g/l (0.5-2.0)

My GP has advised I would need to be referred to an haematologist due to the paraprotein being detected and elevated kappa level.

I have researched paraprotein and I understand this is reflective of a disorder of the blood caused by a disease and likely to be either multiple myeloma or MGUS, which I understand is a pre-cancerous condition. My GP has advised it could take several weeks to get a referral to the haematologist, I am really concerned about the results as does it mean I have cancer? Other than the blood results and gout diagnosis I am a fit and healthy 37 year old man. I did have a bout of gout on the actual day of my recent blood test, which I am not sure would have been a potential cause to the abnormalities found?

I play tennis twice a week and have no tiredness/pain etc and only reason I had the blood test was to confirm that I had gout - with my first gout attack happening in August this year followed by a number of gout attacks the last of which 22nd October. Since then I have stopped all alcholol and red meat, which seems to have done the trick!

I am really worried and just really wanted some advice to confirm all these results are very bad and indicative of someone with multiple myeloma. I was not told the number of the M protein only that it had been detected in my blood test.

Any advice would be so much appreciated!

Thanks

Pav

[Multibilly]

Re: Paraprotein found during gout diagnosis - meaning?

by Multibilly on Sat Nov 07, 2015 9:34 am

Hi Pav,

Welcome to the forum!

It's good to hear that your doc is referring you to a hematologist.

Your IgG is only slightly elevated (suggesting that you have only a small amount of paraprotein - aka "M-spike"). When you see the hematologist, he/she will probably run a serum protein electrophoresis test to measure the actual paraprotein level. Your kappa free light chain is also only slightly elevated. Both of these findings are consistent with the immuofixation test picking up an IgG Kappa paraprotein.

Your latest calcium level is only 10.24 mg/dL, which is also not especially worrisome. Do you know your straight hemoglobin level (Hgb, etc) - not the mean hemoglobin concentration? Your creatinine level from the metabolic panel that gave you your calcium level is also a useful thing to look at.

While I'm not a doc and only a doc should provide a diagnosis, this really sounds like a very early case of MGUS, which is technically not a diagnosis of cancer. Note that the chance of MGUS evolving into symptomatic multiple myeloma is only about 1%/year and most people with MGUS go through life none the worse for it. If it is MGUS, going forward your doc might end up checking you every 6 months for a year or two and then switch to annual testing to monitor it.

Lastly, I wouldn't fret about having to wait several weeks to see a hematologist with these kinds of numbers. Nothing that you said is screaming "get to a hematologist right away", IMHO.

[pavgill]

Re: Paraprotein found during gout diagnosis - meaning?

by pavgill on Sat Nov 07, 2015 8:14 pm

Hi Billy,

Thanks so much for taking the time to come back to me.

I really didn't have a clue what the numbers on my bloods were or what they meant!

So thanks for giving me a better understanding. It is much appreciated and it's a relief the numbers are not totally out of sync.

Not sure what my total hemoglobin was but my creatinine level was 88 umol/L (59-104) range.

Wil see my hematologist with slightly less dread now. ! I appreciate you're not a doctor, but thanks so much for giving this advice. I wish you all the best and can't thank you enough!

Cheers
Pav

[pavgill]

Re: Paraprotein found during gout diagnosis - meaning?

by pavgill on Wed Dec 16, 2015 3:14 pm

Hi Guys,

I was referred to a hematologist by my GP around 6 weeks ago due to the discovery of an M protein in a routine blood test. I am based in the UK and a non urgent referral to a specialist can take up to 3 months, so my scheduled appointment with the hematologist is not for another month or so.

At time of the routine blood test I had no symptoms and was fit and well, however in the last 5/6 weeks I have developed a niggly lower left back pain which I cannot seem to shrug off. As lower back pain is one of the main symptoms of multiple myeloma, I recently went back to my GP to advise him of this. He was honest with me and said he was not a multiple myeloma expert but would run the relevant blood tests and if anything was suspicious he would ask for an urgent referral.

I have managed to get my blood results from the practice and just really wanted some opinions if any of the numbers should require me to push for an urgent referral.

Note these are in UK format

6 weeks ago individual IGs were as follows;
Immunoglobulin A 1.99 g/l (Normal 0.8-3.0)
Immunoglobulin G 16.12 g/l (Normal 5.4-16.1)
Immunoglobulin M 0.58 g/l (Normal 0.5-2.0)

This time;

Immunoglobulin A 1.97 g/l (Normal 0.8-3.0)
Immunoglobulin G 15.97 g/l (Normal 5.4-16.1)
Immunoglobulin M 0.56 g/l (Normal 0.5-2.0)

6 weeks ago;
Serum Protein 81 g/l (Normal 60-80 g/l)

This time;
Serum Protein 83 g/l (Normal 60-80 g/l)

All other results - FBC, platelets, creatinine, urea, haematocrit etc were all similar to what they were 6 weeks ago and in "Normal" range.

This time the GP did a test to also check my quantity of paraprotein (reported as IgG kappa) which came back at 8 g/l, which I believe translates to 0.8 in the US measure?

Is there anyway to find out what my paraprotein level was 6 weeks ago by just measuring the immunoglobulin values? All of the immunoglobulin values seemed to have come down slightly, which I do not know is a good or bad thing, but this time it did put me in all the normal ranges.

Initially my GP had advised it was probably likely to be MGUS, but this was before my lower back pain and confirmation of the quantity of my paraprotein. Is this likely to be multiple myeloma or MGUS?

Just really wanted to know if I should be pushing for an urgent referral based on these results and now having developed lower back pain which, may I add, is not severe, just more of an awkward type of pain.

Any advice as ever would be greatly appreciated - thanks guys!

[Multibilly]

Re: Paraprotein found during gout diagnosis - meaning?

by Multibilly on Wed Dec 16, 2015 3:48 pm

Hey Pavgill,

You really can't derive an M-spike value from the immunoglobulin levels since they normally fluctuate so much from day to day. In your case, the magnitude of the changes in your immunoglobulin levels is insignificant, IMHO.

But if you have an M-spike, an elevated calcium level, and lower back pain, can your GP simply order an MRI (or at least an xray ... although MRI would be preferable) to look for any multiple myeloma-related issues in your spine? I don't think that would be an unreasonable request under the circumstances, but I have no idea how the UK health system works.

[DebbieJ54]

Re: Paraprotein found during gout diagnosis - meaning?

by DebbieJ54 on Fri Dec 18, 2015 8:48 am

Another consideration when choosing a hematologist/oncologist might be to look for one that specializes in myeloma. As long as the wait seems lengthy, maybe you can find this type of specialist. It's important to have someone who can make decisions about if to treat, when to treat, and how to treat. Also, he/she will run the various tests to look for additional effects that the disease could be having on your body.

I have/had very low readings, feel completely healthy, teach fitness classes at 61 y/o, but numerous sclerotic lesions were found throughout (very rare) which prompted the doctor to move toward stem cell transplant. Without finding those lesions, I would have just had MGUS.

So, if your primary care doctor could order the MRI to check for bone lesions, that is something that could give you more information about how soon you need to be seen for potential treatment.

[lucifer]

Re: Paraprotein found during gout diagnosis - meaning?

by lucifer on Fri Mar 31, 2017 7:02 am

Any follow up on this Pav?

Best wishes.

[Taff]

Re: Paraprotein found during gout diagnosis - meaning?

by Taff on Sat Apr 01, 2017 7:46 pm

As you are UK based, if you're suspected of having active myeloma, you'll invoke a 2-week rule for a consultation with a haematologist who specialises in myeloma.

They will order all the required tests and you will have a dedicated team who you can contact if necessary. It really is, or at least is in my case, very organised and efficient.