[gm123]

"Presence of a monoclonal protein cannot be ruled out"

by gm123 on Tue Nov 28, 2017 4:08 pm

Hello,

I recently had high IgA (783 mg/dl). The test was done for celiac disease evaluation. Along with IGA, Gliadin Deamidated AB IgA was high as well.

Repeat IgA (10 months after the aforementioned IGA test) was 869 mg/dl (81-463) normal range.

SPEP results were as follows (in g/dl) with Beta 2 as high.

Total protein 7.9 (6.1-8.1 normal)
Albumin 4.4 (3.8-4.8 normal)
Alpha 1 Globulin 0.2 (0.2-0.3 normal)
Alpha 2 Globulin 0.6 (0.5-0.9 normal)
Beta 1 Globulin 0.6 (0.4-0.6 normal)
Beta 2 Globulin: 0.7 (0.2-0.5 normal)
Gamma 1.5 (0.8-1.7 normal)

Interepration was as follows:
Electrophoretic studies revealed an isolated elevation of beta-2 globulins. This pattern is sug­gestive of acute inflammation; however, the presence of a monoclonal protein cannot be ruled out. Consider serum immunofixation to rule out monoclonal protein (if not already ordered).

Other tests include positive ANA with speckled pattern and high ESR at 27

My primary care physician didn't feel a need for further evaluation.

Does this sound like a myeloma / MGUS issue? And should I follow up with a hematologist?

[Jonah]

Re: "Presence of a monoclonal protein cannot be ruled out"

by Jonah on Tue Nov 28, 2017 6:15 pm

It's probably nothing, given that the SPEP test did not note the presence of an M-spike, which would signal the presence of monoclonal protein, which is what is produced if you have MGUS or multiple myeloma (healthy people don't have monoclonal immunoglobulins; they only have polyclonal immunoglobulins). However, IgA M-spikes can be harder to discern than IgG M-spikes, particularly for relatively low M-spikes like the one that might be present in your case (on the outside chance that you have one.) So, for peace of mind, why don't you go back to your PCP and ask her/him to order a serum immunofixation test. I doubt your PCP will mind.

Plus, if you really want to cover your bases, check if your PCP will also order a serum free light chain test.

Again, it's probably nothing, but the immunofixation and free light chain tests are easy to do and relatively cheap, and they'll give you peace of mind.

If your PCP is unwilling to do the extra blood tests, then I would consult with a hematologist. That really won't be necessary, however, if your PCP is willing to order the tests, and they come up negative for any signs of a monoclonal gammopathy.

[gm123]

Re: "Presence of a monoclonal protein cannot be ruled out"

by gm123 on Wed Nov 29, 2017 3:06 pm

Thanks for the reply. I probably need to find a hematologist as my PCP doesn't seem com­fort­able inter­pret­ing the results of additional tests.