I am wondering if I'm worrying over nothing.
I'm 39, fit, and healthy, etc. Had a stroke 6 months ago due to a single narrowed lesion in the middle cerebral artery of the brain, I had a clot which got resolved successfully with lysis.
Since this I've had many many blood tests, CT's, PET (nothing to note), MRI /MRA, etc to find a reason for the narrowing as I'm rather healthy for this – low cholesterol, blood pressure, weight, etc. I was also found to have mesenteric lymphadenopathy. My bloods showed raised IgA and low IgM, high free kappa, and high free kappa lambda ratio. No paraprotein in the urine. I've had bone pain and joint swelling over the last 6 months and a wide spread rash.
Neurology have referred me to gastroenterology and hematology, who I see over the next 2 weeks.
Thanks for any info or your experiences.
Si
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Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
My most recent results have been:
Free Kappa 34.2 - norm 3.3-19.4 mg/l
Free Lambda 17.8 - norm 5.71-26.3 mg/l
Kappa Lambda Ratio 1.92 - norm 0.26-1.65
IgA 6.29 - norm 0.8-2.80g/l
IgM 0.31 - norm 0.5-2.00g/l
IgG 8.54 - norm 6.0-16.0g/l
Think I had low platelet level but havent any results to hand at the moment.
Thanks
Free Kappa 34.2 - norm 3.3-19.4 mg/l
Free Lambda 17.8 - norm 5.71-26.3 mg/l
Kappa Lambda Ratio 1.92 - norm 0.26-1.65
IgA 6.29 - norm 0.8-2.80g/l
IgM 0.31 - norm 0.5-2.00g/l
IgG 8.54 - norm 6.0-16.0g/l
Think I had low platelet level but havent any results to hand at the moment.
Thanks
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greenfieldshere - Name: Simon
- Age at diagnosis: 39
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Hi Simon,
Welcome to the forum.
First it's good that your PET/CT came up clean with respect to being worried about multiple myeloma.
I'm not a doc, but the fact that you have an elevated IgA and a slightly higher-than-normal free light chain ratio would be enough reason to run some additional tests to look for monoclonal protein. I have no experience with your other conditions and can't comment if they might be impacting your immunoglobulin and free light chain numbers.
If you haven't had a serum protein electrophoresis test and a serum immunofixation test, you should definitely get these tests done when you see the hematologist. I would also go back and look at your hemoglobin, calcium and creatinine levels on your CBC and metabolic panel tests to see if they are in or out of range or approaching any of the limits of their normal ranges.
Was your urine test a spot collection or a 24 hour urine collection test? A spot urine test is pretty useless at telling you if any monoclonal protein is present and a 24 hour urine test isn't definitive in determining if there is monoclonal protein in your blood or not. You really also need to have serum protein electrophoresis and serum immunofixation test to make that call.
There's not a lot I can tell you until you run these additional tests to see if there is any monoclonal protein present in your blood. Good luck with your follow up appointments.
Welcome to the forum.
First it's good that your PET/CT came up clean with respect to being worried about multiple myeloma.
I'm not a doc, but the fact that you have an elevated IgA and a slightly higher-than-normal free light chain ratio would be enough reason to run some additional tests to look for monoclonal protein. I have no experience with your other conditions and can't comment if they might be impacting your immunoglobulin and free light chain numbers.
If you haven't had a serum protein electrophoresis test and a serum immunofixation test, you should definitely get these tests done when you see the hematologist. I would also go back and look at your hemoglobin, calcium and creatinine levels on your CBC and metabolic panel tests to see if they are in or out of range or approaching any of the limits of their normal ranges.
Was your urine test a spot collection or a 24 hour urine collection test? A spot urine test is pretty useless at telling you if any monoclonal protein is present and a 24 hour urine test isn't definitive in determining if there is monoclonal protein in your blood or not. You really also need to have serum protein electrophoresis and serum immunofixation test to make that call.
There's not a lot I can tell you until you run these additional tests to see if there is any monoclonal protein present in your blood. Good luck with your follow up appointments.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Urine was a one of tests, but not the 24 hour.
I found an SPE result that says no paraprotein, which I take is good.
Many thanks for your help. It's much appreciated.
I found an SPE result that says no paraprotein, which I take is good.
Many thanks for your help. It's much appreciated.
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greenfieldshere - Name: Simon
- Age at diagnosis: 39
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
The fact that your SPE came back clean is indeed a good sign and suggests (but doesn't rule out) that this is NOT a monoclonal gammopathy. I would ask for the serum immunofixation test and also a 24 hour urine test just to be safe.
I looked up mesenteric lymphadenitis and it looks like it is an inflammation of the lymph nodes and these lymph nodes are also involved with various IgA processes. Inflammation can also raise one's immunoglobulin levels and free light chain values. So maybe this is all just a result of that condition? But I'm way out of my league on that subject and your docs really need to comment.
I looked up mesenteric lymphadenitis and it looks like it is an inflammation of the lymph nodes and these lymph nodes are also involved with various IgA processes. Inflammation can also raise one's immunoglobulin levels and free light chain values. So maybe this is all just a result of that condition? But I'm way out of my league on that subject and your docs really need to comment.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Thanks for the advice. I'm seeing the consultant about the lymph stuff today and the blood consultant in 2 weeks time. Hopefully they'll rule out anything sinister going on.
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greenfieldshere - Name: Simon
- Age at diagnosis: 39
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
I found serum protein electrophoresis carried out a few months ago -
Serum total protein - 74 g/l (60-80)
Serum Albumin - 47 g/l (35-50)
Serum globulin - 27 g/l (18-36)
Paraprotein - not detected
Not sure if this adds anything. I see a consultant haematologist who specializes in myeloma on Monday who I hope can clear things up.
I also read that people with multiple myeloma and its related conditions MGUS / SMM were at risk of blood clots.
My stroke 6 months ago was caused by an unexpected blood clot.
Serum total protein - 74 g/l (60-80)
Serum Albumin - 47 g/l (35-50)
Serum globulin - 27 g/l (18-36)
Paraprotein - not detected
Not sure if this adds anything. I see a consultant haematologist who specializes in myeloma on Monday who I hope can clear things up.
I also read that people with multiple myeloma and its related conditions MGUS / SMM were at risk of blood clots.
My stroke 6 months ago was caused by an unexpected blood clot.
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greenfieldshere - Name: Simon
- Age at diagnosis: 39
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Saw the hematologist who took bloods, did an x-ray, and booked another appointment for 8 weeks time. They assured me the rises are small and likely insignificant.
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greenfieldshere - Name: Simon
- Age at diagnosis: 39
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Perhaps you will find this useful. It is the new criteria for diagnosing multiple myeloma.
Updated Definition of Multiple Myeloma
The revised IMWG criteria will allow, in addition to the classic CRAB features, the following three markers as “myeloma defining events” (MDEs).
Here is a link to the full article in the Beacon:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
Your presentation is not anywhere close to these. You will note, that insofar as the light chains are concerned the involved light chain would have to have a reading of at least 100 AND a ratio over 100.
Perhaps this will help ease your concerns.
Updated Definition of Multiple Myeloma
The revised IMWG criteria will allow, in addition to the classic CRAB features, the following three markers as “myeloma defining events” (MDEs).
- Sixty percent or greater clonal plasma cells on bone marrow examination
- Serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved free light chain is at least 100 mg/L (a patient’s “involved” free light chain – either kappa or lambda – is the one that is above the normal reference range; the uninvolved light chain is the one that typically is in, or below, the normal range)
- More than one focal lesion on MRI that is at least 5 multiple myeloma or greater in size.
Here is a link to the full article in the Beacon:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
Your presentation is not anywhere close to these. You will note, that insofar as the light chains are concerned the involved light chain would have to have a reading of at least 100 AND a ratio over 100.
Perhaps this will help ease your concerns.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Raised IgA, low IgM, high kappa & kappa-lambda ratio
Many thanks for your information there. That's reassuring.
I have been back to my blood consultant and he wants blood tests done every ten weeks for awhile, I guess to see if anything changes.
The results of the past 4 blood tests over the last 6 months have been fairly consistent
Raised IgA and low IgM
Raised free kappa and abnormal ratio
My consultant didn't really say anything was wrong ,just that I'm fine and they'll keep an eye on the blood tests.
He did mention getting an skeletal x ray done.
Do you think these results point to MGUS even though no paraprotein has been detected?
I have been back to my blood consultant and he wants blood tests done every ten weeks for awhile, I guess to see if anything changes.
The results of the past 4 blood tests over the last 6 months have been fairly consistent
Raised IgA and low IgM
Raised free kappa and abnormal ratio
My consultant didn't really say anything was wrong ,just that I'm fine and they'll keep an eye on the blood tests.
He did mention getting an skeletal x ray done.
Do you think these results point to MGUS even though no paraprotein has been detected?
-
greenfieldshere - Name: Simon
- Age at diagnosis: 39
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