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Questions and discussion to help forum members determine if they may have multiple myeloma, smoldering multiple myeloma, or MGUS.

Question re: Pre-Diagnosis Labs with Compression Fracture

by Onemelody on Wed Jul 27, 2011 10:53 pm

Hello, everyone! I'm new here and I'm hoping to get to know you as time goes on...my story is long so I won't bore you now with the details...:) But after a couple years of increasing bone pain, osteopenia that has progressed to osteoporosis, and recent diagnosis of a T11 compression fracture, the doc ordered the following tests that I do not understand! My follow up appointment isnt until the end of September but I did manage to obtain the following. I understand that some tests are normal, but I'm totally confused as to what the FLC's mean...and if it's positive simply because they are there. I'm progressively getting weaker, my muscles are wasting, I have carpel tunnel for no reason, and I've shrunk an inch and a half this year. The bone pain is a nightmare in my back, legs, hips, and now my ribs. I had a total hysterectomy in April due to endocrine failure and an elevated OVA1....which ended up being benign. I have a history of kidney stones and poor circulation and I just turned 40....that's way toooooo young..:) The only other information is that I have Dextrocardia with 2 anomalous connections (my heart is on the right instead of the left)...and I never had a problem with that until all of this began a couple years ago at which time i ended up with addrenal insuffiency and possible CHF and MI....OUT of the BLUE it seemed. The bone pain began in my left shin with a warm red circle area on the skin....no specialist in my area could ever figure it out and ended up saying there was mild marrow edema and it must be a stress fracture. ANYWAY!! For now....my questions are pertaining to the following and I'm wondering if any of you can shed some light....or maybe have some experience with the following. Thank you in advance for any time you are able to give....blessings...:)

SPEP: normal

UPEP:

Pattern is consistent with a mixed glomerular-tubular protinuria. 24 hour urinary total protein excretion is 102 mg/d which is normal.

Total Protein, Urine (TPX) 17 mg/dL
Albumin, Elec, Urine 7mg
A1 Glob 1 mg
A2 Glob 2 mg
B1 Glob 2 mg
B2 Glob 2mg
Gammaglobulin 4 mg

Kappa Quantitative Free Light Chains 1.53 (ref 0.33-1.94 mg/dL)
Lambda Quantitative Free Light Chains 1.41 (ref 0.57-2.63 mg/dL)
Kappa Lambda Free Light Chain Ratio 1.90 (ref 0.26-1.65)

Bone Spec Alk Phos 25.7 ug/L
Creatinine Clearance, Uncorrected 119 mL/min
Phosphorus, Urine 86.7 mg/dL
Potassium 3.2 mmol/L
Osteocalcin 37

They did not due a regular CBC....but in the past, just FYI....my RDW, MPV, VIT D have usually run on the low side.....and MCH, MCHC, ALK PHOS, PTH, nBUN/CREAT, AST, ALT, Monocytes, Thyroid Antibodies, Thyroid Globulin, have run on the high side.......I don't currently have any information regarding the hemoglob or hemocrit or WBC or RBC...
Also, in April 2011, my urine came back: Mixed flora present = Biotype 1 Staphy, Biotype 2 Staphy, Alpha Hemolytic Strepto vs Gram Positive Rod , and hematuria. And in the past, maybe two years ago, my blood work came back ANA positive 1:60 for possible Lupus...of which I've been told is probably not the case. And when my second of three children was born in 2001, I was told afterwards that I was Strep B positive....and yes, he was born without antibiotics, but is doing well.
Soooooo....wanna know the color of my eyes, too??? LOL

Thanks!!!!!

Onemelody

Re: Question re: Pre-Diagnosis Labs with Compression Fractur

by Dr. Edward Libby on Thu Jul 28, 2011 8:21 pm

Hi,
The major tests used to diagnose or exclude mutiple myeloma are the SPEP, UPEP and serum free light chains. Yours are essentially normal. The slight abnormal FLC ratio is not very concerning. If you are not anemic and your creatinine is normal I am not very concerned. The only way to completely rule out myeloma is to have a bone marrow biopsy and xrays of all of the major bones. I am not necessarily recommending these because I do not have all of the information your doctor has.

Dr. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor

Re: Question re: Pre-Diagnosis Labs with Compression Fractur

by Onemelody on Fri Jul 29, 2011 3:53 pm

Dr. Libby,
I first just want to thank you for your reply....it may or may not surprise you that your response is more than I've been able to get from my own personal physician. However, he did order these tests and for that, I am grateful.

Also....does everyone have FLC...in the normal range...in their urine??? Or is the urine abnormal simply because they are there?!?!?

And....I understand that the UPEP results are basically in the normal ranges (Album, A1, etc...) but what do my values mean when people talk about an M-Spike?!?!? Is that the value under Gammaglobulin ????

I wanted to give you slightly more information and ask you if it effects your opinion at all. I completely understand that you do not know the full picture....but the nephrologist that ordered these tests does not, as well. We were in the same room for no more than 5 minutes...and that was due to him seeing that I had an unexplained T11 Compression fracture, osteoporosis, and repeated kidney problems.

Here is the additional information I have....thank you so very much for your time!!!!

His "comments" section revealed that I have an extra ureter on one kidney, distended veins, previous unexplained pathological stress fracture in the tibia, pale color with history of anemia. Currently has progressive bone pain in major joints and evidence of muscle wasting in legs and arms and hands. Patient is "bluish" with purple bruising unexplained. Order Multiple Myeloma screen.

April 2011 Hemogram And BMP

RBC 3.47 M
Hemoglobin 11.1 g
Hemacrit 32.5%
un/Crea ratio 22
Anion gap 5 mmol

Additional values:

SPEP: (normal...but here are the values)

Serum protein: 6.6 g/dL
Albumin, Electro, Serum: 4.4 g
A1 Glob .2g
A2 Glob .6
B1 glob .4
B2 Glob .4
Gammaglobulin .8


Anion Gap 9 mmol/L
Calcium, Total 9.4 mg/dL
Albumin level 4.1 g/dL



Creatinine clearance:

Creatinine clearance, Uncorrected was 119 m (ref 72-114mL/min)
Creatinine, urine 212 mg/dL
Creatinine/day 1272 mg
Creatinine plasma .71 mg


Ionized calcium, serum 5.1 mg

Onemelody

Re: Question re: Pre-Diagnosis Labs with Compression Fractur

by Dr. Edward Libby on Fri Jul 29, 2011 9:13 pm

One can have very small amounts of free light chains and still be normal. The results you posted show that. (see below)
Kappa Quantitative Free Light Chains 1.53 (NORMAL RANGE ref 0.33-1.94 mg/dL)
Lambda Quantitative Free Light Chains 1.41 (NORMAL RANGE 0.57-2.63 mg/dL)
Kappa Lambda Free Light Chain Ratio 1.90 (NORMAL RANGE 0.26-1.65).
As I said the elevation in the free light chain ratio is so minimal I cannot get excited about it. Nonsecretory myeloma is becoming very very rare because our tests now can detect the myeloma protein is vast majority of patients. The most simple and least invasive way to further rule out myeloma is to have a "skeletal survey" or xray of all of your major bones.

Dr. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor


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