[outdoorgirl]

Stable MGUS, reduced liver function

by outdoorgirl on Sun Jun 11, 2017 3:05 am

Hi all,

I am hoping some of you may be able to shed some light on some sudden serum tests that have come back as abnormal. My MGUS has remained stable for 6 years since diagnosis. However, a recent batch of tests have revealed reduced liver function and a pattern of a low white cell count and low neutrophils over the past few months.

I am having a liver ultrasound next week, had a recent PET scan which showed all clear, and am having an MRI next week due to ongoing back, hip, and groin pain which has been worse in the last 12 months and as a consequence are taking Lyrica (pregabalin) and Targin (oxycodone & naloxone).

Can anyone identify a reason why the sudden decline in liver function? Any ideas would be most helpful.

Serum Protein Electrophoresis

Total Protein: 70 g/L (65-85
Albumin: 35 g/L (36-49)
Alpha-1-Globulins: 2.3 g/L (2.1-3.5)
Alpha-2-Globulins: 6.4 g/L (5.1-8.5)
Beta-1-Globulins: 4.5 g/L (3.4-5.2)
Beta-2-Globulins: 2.5 g/L (2.3-4.7)

IgG: 15.7 g/L (5.2-16.0)
IgA: 109 g/L (0.85-3.50)
IgM: 1.27g/L (0.32-3.00)
IgG (Kappa) 8 g/L

Free Light Chain Quant

Kappa FLC 28 mg/L (up to 20)
Lambda FLC 10 mg/L (up to 30)
K/L Ratio 2.8 (0.3-1.6)

(x10 ^9 /L
White Cell Count 3.0 (4.0-11.0)
Neutrophils 37% 1.1 (2.0-8.0)

Serum/Plasma Biochem

Total Billirubin: 20 umo1/L (<15)
ALT: 372 U/L (<35)
AST: 372 U/L (<35)
ALP: 186 U/L (30-115)
GST: 122 U/L (<35)
Albumin: 35 g/l (36-49)

[Multibilly]

Re: Stable MGUS, reduced liver function

by Multibilly on Sun Jun 11, 2017 7:42 am

Hi Susan,

Given you have a diagnosis of MGUS, I think the doctor would likely try to rule out amyloidosis. Hepatitis or an infection can also raise your ALT and AST levels and lower your white blood cell counts. Oxycodone can also impact your ALT and AST levels (although my understanding is that this usually happens if you are also taking acetaminophen with the oxycodone).

In any case, I'm sure that your doctor will systematically eliminate all of the possibilities and is your best source to speculate about this. Good luck and let us know how things go.

[outdoorgirl]

Re: Stable MGUS, reduced liver function

by outdoorgirl on Sun Jun 11, 2017 7:57 am

Thanks for your reply Multibilly,

I have just had a PET scan this week and showed all clear, does this test rule out amyloidosis, and would my free light chain ratio be much more elevated if amyloidosis were present? I am a non-drinker, non-smoker, and have never taken illegal drugs, and am at a normal weight for my age and height. I am having an ultrasound on my liver this week; would that identify amyloidosis?

Thanks for the advice.

[Multibilly]

Re: Stable MGUS, reduced liver function

by Multibilly on Sun Jun 11, 2017 9:00 am

Systemic amyloidosis (which is what light chain AL amyloidosis is) isn't readily picked up on a PET/CT. See: https://www.ncbi.nlm.nih.gov/pubmed/23474745 I'm not qualified to comment on how good ultrasound may be for evaluating the presence of amyloidosis in one's liver.

Light chain amlyoidosis can present with an FLC ratio of 3: http://cjasn.asnjournals.org/content/1/6/1331.full

"In AL amyloidosis, the clonal plasma cells express light chains of the λ isotype more frequently than the κ, with a ratio of approximately 3:1, despite the greater proportion of κ than λ expressing plasma cells in a normal bone marrow."

But usually, if there is a strong suspicion of amyloidosis, you would have the suspect organ biopsied (a needle biopsy) or you would biopsy a small piece of fat from your abdomen and do a red Congo stain test on the biopsy sample to look for amyloid proteins.

But, you should keep in mind that you are getting some comments on the internet from a layman and take all this with a big grain of salt. Your doctor is the best person to comment on all this.

[outdoorgirl]

Re: Stable MGUS, reduced liver function

by outdoorgirl on Sun Jun 11, 2017 9:16 am

Hi Multibilly,

You are far more knowledgeable than me when it comes to this disease. I respect your comments and will follow up with my specialist.

Cheers,
Susan