[Renraj Mani]

Serum protein electrophoresis results - meaning?

by Renraj Mani on Sun Jan 03, 2016 12:02 am

Hello all ,

Need an opinion on the attached protein electrophoresis serum test result of my mother (aged 64). Our medical practitioner has suggested for bone marrow test based on this result . i would like to understand the test result and any worrying factor in this.

Protein Electrophoresis, Serum

Test name Result Units Bio. Ref

Protein Total 6.70 g/dL 6.40 - 8.10
Albumin 3.01 g/dL 3.50 - 5.64
Alpha-1 Globulin 0.68 g/dL 0.17 - 0.41
Alpha-2 Globulin 0.62 g/dL 0.31 - 0.85
Beta Globulin 0.42 g/dL 0.49 - 1.32
Gama Globulin 1.97 g/dL 0.62 - 1.53
A/G Ratio 0.87 0.90 - 2.00
M / Spike 1.22 g/dL

Regards,
Raj

test result

Protien Electrophoresis.png (564.12 KiB) Viewed 1424 times

[TerryH]

Re: Serum protein electrophoresis results - meaning?

by TerryH on Sun Jan 03, 2016 9:40 pm

Your mother has an M-spike of 1.22 g/dL (12.2 g/L). This means she has a monoclonal protein in her blood, indicating she very likely has some kind of plasma cell disorder, such as monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma, multiple myeloma, or amyloidosis.

Your mother's physician will need to do additional testing to determine what the appropriate diagnosis is. The diagnosis may be something as relatively benign as MGUS, which does not require treatment, or something more serious that requires treatment and is life threatening if untreated, such as multiple myeloma.

Your mother's doctor should be doing further blood tests to see if she has signs of anemia, kidney damage, or bone deterioration, and also imaging (xrays or MRIs) to see if there are any lesions in your mother's bones.

There also is another useful blood test, known as the serum free light chain assay, which should be run to help with your mother's diagnosis.

You can find information on the criteria for differentiating between multiple myeloma -- which requires treatment – and smoldering multiple myeloma and MGUS, which physicians currently do not treat, at this link:

SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014

Good luck!

[Renraj Mani]

Re: Serum protein electrophoresis results - meaning?

by Renraj Mani on Wed Jan 06, 2016 6:33 am

Hello Terry & all,

Please see the bone marrow test result:

Specimen: Bone marrow
Microscopy: Cellular marrow fragments showing normal erythropoiesis, myelopoesis show many atypical plasma cells 22% with central nucleus. High N/c ratio. Abundant cytoplasm and many showing peri nuclear halo . Rest are all maturing myeloid cells. megakaryopoesis is normal. background RBC’s show rouleaux formation.

Appreciate your guidance on next course of action. Is the recommended option to investigate further? Or imaging (x-ray) to see if there are any lesions?

Regards,
Renraj

[JPC]

Re: Serum protein electrophoresis results - meaning?

by JPC on Wed Jan 06, 2016 8:24 am

Hello Renraj:

I second everything that Terry has said. The link she provided will also be informative for you. But generally, and qualitatively, although it is certainly possible that there is active myeloma at an M-spike of about 1, it is also highly possible it's just MGUS. MGUS turns to smoldering and active myeloma as symptoms appear, and is typically associated with the M-spike starting to rise at a faster rate.

So a thorough evaluation of the symptoms need to be made by a knowledgeable doctor, preferably a myeloma specialist. If it's MGUS, the typical approach is called "watch and wait", and the M-spike is measured every 3 months or so.

If the M-spike starts moving up over time, however, you do want to monitor it more frequently, and start initial induction treatment well before any bad effects of the myeloma start, if possible.

[Renraj Mani]

Re: Serum protein electrophoresis results - meaning?

by Renraj Mani on Sat Jan 16, 2016 6:46 am

Hello team ,

Please see the below test result. Can we confidently say myeloma is not present and no evidence of myeloma? if yes what are the precautionary measures I have to take? Any periodic test ?

Biochemistry

Calcium - 9.5 mg/dl (8.6-10.2)
Potassium - 5.7 mmol/L (3.5- 5.3)

Renal function test (RFT)

Urea - 79 mg/dl (10-40)
Creatinine - 1.40 mg/dl (0.60-1.10)

Result of Immunohistochemistry

Immunohistochemical studies reveal a polyclonal population of plasma cells positive for CD138 and for kappa and lambda with a lambda predominance, involving approximately 5% of the marrow .

Impression
Bone marrow aspirate and biopsy

Panmyeloid hyperplasia with megaloblastoid erythroid cells
Reticulin fibrosis ; increased iron
No evidence of myeloma

Regards,
Renraj