Hi,
I hope it's ok that I registered here as I haven't been diagnosed with multiple myeloma and hope this is a false alarm.
I have been having over the past few months rather sudden health issues, which include a gallbladder attack and hospitalization to have it removed, and then leukocytoclastic vasculitis (LCV) which caused painful sores and swelling (and joint pains) on my feet and legs. I'm still battling the LCV, which has improved. But then I ended up back in the hospital with valley fever. I'm trying to recover from that and still have severe joint pains.
Anyway, all these different doctors treating me have run so many tests.
I got a phone call about these labs indicating that I had "abnormal red blood cells" where they are clumping together like a stack of coins. She further mentioned that a serum protein electrophoresis was done with abnormal results. She wants me to go in for further testing, but my insurance tries to restrict me to one doctor at a time, which is difficult when dealing with so much. The doctor I'm used to seeing was rather dismissive about this and indicated that it was probably just inflammation, yet he didn't even look at the labs yet. He didn't seem to know what "immunofixation analysis" was either.
I happen to have MyChart, which lets me view these labs online and basically the serum protein electrophoresis (SPE, or SPEP) showed elevated beta 2 and gamma globulins and I think one of the alpha ones was elevated, and then it showed two abnormal protein bands. She indicated she wants to rule out cancers and have further testing.
When I search the internet with these test results, pretty much all I'm getting is article after article on multiple myeloma, so naturally I'm concerned.
As this is a community dealing with multiple myeloma, I am hoping some people might be able to clarify some of this for me. I realize no one can give medical advice, so I'm looking for basic information. I really want to get these tests done and am not comfortable with my current doctor being somewhat dismissive about it.
Thank you for your time.
Forums
Re: Abnormal SPE results - 2 abnormal protein bands
Hello sbd1984,
The "abnormal protein bands" in your SPEP test results are most likely the levels of any paraproteins (monoclonal proteins) that were found.
Is there any chance you could copy and paste all your SPEP results, including the interpretation section? Or you could just let us know what the results were for the two abnormal protein bands (please include units).
Did you have a serum immunofixation done as well? Similarly, did you have a serum free light chain test done?
If you had either of those tests done, their results also would be good to know.
Other lab results that shed more direct light on whether you might have multiple myeloma are your immunoglobulin levels (IgA, IgG, and IgM), your hemoglobin level, and your serum creatinine and calcium levels.
As you may already know, all of these results come into play when determining whether or not the criteria for a multiple myeloma diagnosis are fulfilled. Those criteria are very specifically defined, and outlined in this article:
Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
The "abnormal protein bands" in your SPEP test results are most likely the levels of any paraproteins (monoclonal proteins) that were found.
Is there any chance you could copy and paste all your SPEP results, including the interpretation section? Or you could just let us know what the results were for the two abnormal protein bands (please include units).
Did you have a serum immunofixation done as well? Similarly, did you have a serum free light chain test done?
If you had either of those tests done, their results also would be good to know.
Other lab results that shed more direct light on whether you might have multiple myeloma are your immunoglobulin levels (IgA, IgG, and IgM), your hemoglobin level, and your serum creatinine and calcium levels.
As you may already know, all of these results come into play when determining whether or not the criteria for a multiple myeloma diagnosis are fulfilled. Those criteria are very specifically defined, and outlined in this article:
Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
Re: Abnormal SPE results - 2 abnormal protein bands
Building on what Terry posted, the "stack of coins" blood formations sounds very much like rouleaux, which can occur in patients with a plasma cell disorder such as multiple myeloma, or with other cancers, or could simply be due to inflammation or an infection.
It's concerning that your doc doesn't know what an "immunofixation" test is. If I had both rouleaux and two abnormal protein bands show up on an SPEP, I would be heading to a hematologist-oncologist to get to the bottom of this. But if you need to continue to work with your current doc for now, I would be insisting that he/she run the following tests:
It's concerning that your doc doesn't know what an "immunofixation" test is. If I had both rouleaux and two abnormal protein bands show up on an SPEP, I would be heading to a hematologist-oncologist to get to the bottom of this. But if you need to continue to work with your current doc for now, I would be insisting that he/she run the following tests:
- Serum immunofixation
- Serum protein electorphoresis
- Serum free light chain assay
- Quantified immunoglobulins
- CMP and CBC
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Abnormal SPE results - 2 abnormal protein bands
Thanks to both of you for taking the time. I did read the article and it was informative. Here are lab results:
PROTEIN ELECTROPHORESIS SERUM
Albumin 2.6 g/dL
Alpha 1 Globulin 0.6 g/dL
Alpha 2 Globulin 1.0 g/dL
Beta 1 Globulin 0.6 g/dL
Beta 2 Globulin 1.1 g/dL
Gamma Globulin 3.6 g/dL
Abnormal Protein Band 1 0.9 g/dL
Abnormal Protein Band 2 0.5 g/dL
Abnormal Protein Band 3 DNR
Interpretation
Beta-2 globulins appear increased relative to beta-1 globulins. The presence of a monoclonal protein cannot be ruled out. Please consider immunofixation analysis if indicated and not already ordered.
Evaluation reveals ONE restricted band(s) migrating in the BETA-2 region(s), respectively. Estimated concentration(s): 0.5 g/dL, respectively. Consider immunofixation analysis if indicated and not already ordered.
Evaluation reveals ONE restricted band(s) migrating in the GAMMA region(s), respectively. Estimated concentration(s): 0.9 g/dL, respectively. Consider immunofixation analysis if indicated and not already ordered.
PATHOLOGY SLIDE REVIEW
- Normochromic normocytic anemia. Primary differential includes recent bleed, anemia of chronic disease, marrow suppression, aplasia and compensated hemolytic process.
- Leukocytosis with eosinophilia. Primary differential includes, allergic/hypersensitivity reaction, infection (i.e. parasites), certain skin disorders (e.g. psoriasis), autoimmune conditions, vasculitis and malignancy (especially hematolymphoid neoplasms).
- Red cell rouleaux is also noted, suggesting hypergammaglobulinemia, which may be monoclonal or polyclonal, and is a peripheral blood finding often seen in individuals with plasma cell neoplasms.
COMPREHENSIVE METABOLIC PANEL
Creatinine 0.81 mg/dL
Protein, Total 10.1 g/dL
Albumin 3.4 g/dL
Globulin 6.7 g/dL
Albumin/Globulin Ratio 0.5
Calcium 9.6 mg/dL
CBC WITH AUTO DIFF RFX TO MANUAL
WBC 14.1 k/mm3
RBC 3.63 m/mm3
Hemoglobin 10.1 g/dL
Hematocrit 31.4 %
Eosinophils 13 %
Eosinophils Absolute 1.9 k/uL
PERCENT IMMATURE GRANULOCYTES 1 %
ABSOLUTE IMMATURE GRANULOYCOTES 0.2 k/uL
I included what appears relevant to me but I'm not an expert. Please let me know if this helps or if you need more. Much appreciated.
PROTEIN ELECTROPHORESIS SERUM
Albumin 2.6 g/dL
Alpha 1 Globulin 0.6 g/dL
Alpha 2 Globulin 1.0 g/dL
Beta 1 Globulin 0.6 g/dL
Beta 2 Globulin 1.1 g/dL
Gamma Globulin 3.6 g/dL
Abnormal Protein Band 1 0.9 g/dL
Abnormal Protein Band 2 0.5 g/dL
Abnormal Protein Band 3 DNR
Interpretation
Beta-2 globulins appear increased relative to beta-1 globulins. The presence of a monoclonal protein cannot be ruled out. Please consider immunofixation analysis if indicated and not already ordered.
Evaluation reveals ONE restricted band(s) migrating in the BETA-2 region(s), respectively. Estimated concentration(s): 0.5 g/dL, respectively. Consider immunofixation analysis if indicated and not already ordered.
Evaluation reveals ONE restricted band(s) migrating in the GAMMA region(s), respectively. Estimated concentration(s): 0.9 g/dL, respectively. Consider immunofixation analysis if indicated and not already ordered.
PATHOLOGY SLIDE REVIEW
- Normochromic normocytic anemia. Primary differential includes recent bleed, anemia of chronic disease, marrow suppression, aplasia and compensated hemolytic process.
- Leukocytosis with eosinophilia. Primary differential includes, allergic/hypersensitivity reaction, infection (i.e. parasites), certain skin disorders (e.g. psoriasis), autoimmune conditions, vasculitis and malignancy (especially hematolymphoid neoplasms).
- Red cell rouleaux is also noted, suggesting hypergammaglobulinemia, which may be monoclonal or polyclonal, and is a peripheral blood finding often seen in individuals with plasma cell neoplasms.
COMPREHENSIVE METABOLIC PANEL
Creatinine 0.81 mg/dL
Protein, Total 10.1 g/dL
Albumin 3.4 g/dL
Globulin 6.7 g/dL
Albumin/Globulin Ratio 0.5
Calcium 9.6 mg/dL
CBC WITH AUTO DIFF RFX TO MANUAL
WBC 14.1 k/mm3
RBC 3.63 m/mm3
Hemoglobin 10.1 g/dL
Hematocrit 31.4 %
Eosinophils 13 %
Eosinophils Absolute 1.9 k/uL
PERCENT IMMATURE GRANULOCYTES 1 %
ABSOLUTE IMMATURE GRANULOYCOTES 0.2 k/uL
I included what appears relevant to me but I'm not an expert. Please let me know if this helps or if you need more. Much appreciated.
Re: Abnormal SPE results - 2 abnormal protein bands
It helps if you also include the reference ranges for all the figures you posted (all the labs use different reference ranges). Your hemoglobin looks low, but it's hard to say how severe your anemia is without knowing the hemoglobin reference range. Generally, you are considered to have anemia by myeloma standards if your hemoglobin is 2g/dL under the lower HgB limit of the lab's reference range. Are you feeling fatigued these days?
Having two abnormal bands (M-spikes) is not that unusual and occurs in about 3-6% of patients diagnosed with a monoclonal gammopathy. The condition is known as biclonal gammopathy. Having a biclonal gammopathy doesn't signal any sort of worse prognosis, nor would it suggest any sort of different treatment plan down the road. But again, you really need the immunofixaiton test to confirm that these M-spikes are truly monoclonal in nature, as well as to know which of your immunoglobulin heavy chains (IgG, IgA, IgM) and light chains (kappa, lambda) are being affected.
Often times, a doctor will simply sum the two m-spikes to give you your total M-spike, which would be 1.4g/dL in your case. This is not a high M-spike, nor is it a low M-spike. It's just a middle-of-the-road M-spike level that one might see in an MGUS or smoldering multiple myeloma patient.
I also want to say that I have no idea how your LCV diagnosis would impact any of the markers you posted, but that obviously needs to be factored into this process by a skilled hematologist.
Again, a serum immunofixation is indeed one of the key tests that should be done next, but the other tests we mentioned should also be run. Good luck and let us know how things turn out.
Having two abnormal bands (M-spikes) is not that unusual and occurs in about 3-6% of patients diagnosed with a monoclonal gammopathy. The condition is known as biclonal gammopathy. Having a biclonal gammopathy doesn't signal any sort of worse prognosis, nor would it suggest any sort of different treatment plan down the road. But again, you really need the immunofixaiton test to confirm that these M-spikes are truly monoclonal in nature, as well as to know which of your immunoglobulin heavy chains (IgG, IgA, IgM) and light chains (kappa, lambda) are being affected.
Often times, a doctor will simply sum the two m-spikes to give you your total M-spike, which would be 1.4g/dL in your case. This is not a high M-spike, nor is it a low M-spike. It's just a middle-of-the-road M-spike level that one might see in an MGUS or smoldering multiple myeloma patient.
I also want to say that I have no idea how your LCV diagnosis would impact any of the markers you posted, but that obviously needs to be factored into this process by a skilled hematologist.
Again, a serum immunofixation is indeed one of the key tests that should be done next, but the other tests we mentioned should also be run. Good luck and let us know how things turn out.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Abnormal SPE results - 2 abnormal protein bands
Thanks for following up. I have been feeling very fatigued lately with lightheadedness, overall weakness, joint pains in knees, hands, ankles, and feet. But yet since early September I've had a gallbladder surgery, the LCV, and valley fever (which is a fungus that exists primarily in the SW United States). So doctors have told me that many of these symptoms are from these things, especially as this is a lot to deal with all at the same time.
I did follow up with the insurance company and they said I would need a referral and so I'm going to follow up on Monday to get that process going. My PCP is currently a nurse practitioner and, again, unlike the hospital doctors, he doesn't seem all that familiar with this. He has no idea how to treat the LCV either, which is being treated by a dermatologist. Rather frustrating, so I may be switching to someone else for primary care.
Here is the data with reference ranges:
Protein Electrophoresis Serum
Component Your Value Standard Range
Albumin 2.6 g/dL 3.8 - 4.8 g/dL
Alpha 1 Globulin 0.6 g/dL 0.2 - 0.3 g/dL
Alpha 2 Globulin 1.0 g/dL 0.5 - 0.9 g/dL
Beta 1 Globulin 0.6 g/dL 0.4 - 0.6 g/dL
Beta 2 Globulin 1.1 g/dL 0.2 - 0.5 g/dL
Gamma Globulin 3.6 g/dL 0.8 - 1.7 g/dL
Abnormal Protein Band 1 0.9 g/dL NONE DETECTED g/dL
Abnormal Protein Band 2 0.5 g/dL NONE DETECTED g/dL
Comprehensive Metabolic Panel
Component Your Value Standard Range
Creatinine 0.81 mg/dL 0.60-1.40 mg/dL
Protein, Total 10.1 g/dL 6.0-8.0 g/dL
Albumin 3.4 g/dL 3.3-4.9 g/dL
Globulin 6.7 g/dL 2.0-3.7 g/dL
Albumin/Globulin Ratio 0.5 1.0-2.4
Calcium 9.6 mg/dL 8.7-10.4 mg/dL
CBC With Auto Diff RFX To Manual
Component Your Value Standard Range
WBC 14.1 k/mm3 4.0-11.0 k/mm3
RBC 3.63 m/mm3 3.70-5.40 m/mm3
Hemoglobin 10.1 g/dL 11.5-16.0 g/dL
Hematocrit 31.4 % 35.0-48.0 %
Platelets 440 k/mm3 130-450 k/mm3
Eosinophils 13 % 0-7 %
Eosinophils Absolute 1.9 k/uL 0.0-0.7 k/uL
% Immat. Granulocytes 1 % 0-1 %
Abs. Immat. Granulocytes 0.2 k/uL 0.0-0.1 k/uL
I did follow up with the insurance company and they said I would need a referral and so I'm going to follow up on Monday to get that process going. My PCP is currently a nurse practitioner and, again, unlike the hospital doctors, he doesn't seem all that familiar with this. He has no idea how to treat the LCV either, which is being treated by a dermatologist. Rather frustrating, so I may be switching to someone else for primary care.
Here is the data with reference ranges:
Protein Electrophoresis Serum
Component Your Value Standard Range
Albumin 2.6 g/dL 3.8 - 4.8 g/dL
Alpha 1 Globulin 0.6 g/dL 0.2 - 0.3 g/dL
Alpha 2 Globulin 1.0 g/dL 0.5 - 0.9 g/dL
Beta 1 Globulin 0.6 g/dL 0.4 - 0.6 g/dL
Beta 2 Globulin 1.1 g/dL 0.2 - 0.5 g/dL
Gamma Globulin 3.6 g/dL 0.8 - 1.7 g/dL
Abnormal Protein Band 1 0.9 g/dL NONE DETECTED g/dL
Abnormal Protein Band 2 0.5 g/dL NONE DETECTED g/dL
Comprehensive Metabolic Panel
Component Your Value Standard Range
Creatinine 0.81 mg/dL 0.60-1.40 mg/dL
Protein, Total 10.1 g/dL 6.0-8.0 g/dL
Albumin 3.4 g/dL 3.3-4.9 g/dL
Globulin 6.7 g/dL 2.0-3.7 g/dL
Albumin/Globulin Ratio 0.5 1.0-2.4
Calcium 9.6 mg/dL 8.7-10.4 mg/dL
CBC With Auto Diff RFX To Manual
Component Your Value Standard Range
WBC 14.1 k/mm3 4.0-11.0 k/mm3
RBC 3.63 m/mm3 3.70-5.40 m/mm3
Hemoglobin 10.1 g/dL 11.5-16.0 g/dL
Hematocrit 31.4 % 35.0-48.0 %
Platelets 440 k/mm3 130-450 k/mm3
Eosinophils 13 % 0-7 %
Eosinophils Absolute 1.9 k/uL 0.0-0.7 k/uL
% Immat. Granulocytes 1 % 0-1 %
Abs. Immat. Granulocytes 0.2 k/uL 0.0-0.1 k/uL
Re: Abnormal SPE results - 2 abnormal protein bands
If you let us know what city you are in, folks on this forum can hopefully recommend some facilities nearby that would have some top myeloma specialists. You don't want to go to just any old hematologist/oncologist that your PCP might recommend in general, but rather one that specializes in plasma cell disorders such as multiple myeloma. Hopefully, those facilities with multiple myeloma specialists will be in your insurance network.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Abnormal SPE results - 2 abnormal protein bands
Yes, I guess I should have introduced myself more properly. I'm living in Phoenix, Arizona, am female, and 31 years old. I prefer to keep my name off the forum though.
Re: Abnormal SPE results - 2 abnormal protein bands
Understand about wanting to keep your name off the forum. I do the same and only my immediate family knows about my diagnosis.
The Mayo in Scottsdale is top notch and has some of the best multiple myeloma specialists in the nation.
https://myelomabeacon.org/resources/treatment-centers/#Arizona
The Mayo in Scottsdale is top notch and has some of the best multiple myeloma specialists in the nation.
https://myelomabeacon.org/resources/treatment-centers/#Arizona
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Abnormal SPE results - 2 abnormal protein bands
The one listed there for Arizona is in Tucson, which is about 110 miles away. Not the best choice in terms of distance, but since I do have a car and I like to get out of Phoenix sometimes, it might work, as long as I'm not having to constantly go there all the time. But then if my situation is really serious I'll just have to deal with that.
Thanks for linking me to those resources. I've contacted my insurance company and basically we do have to wait until my PCP reviews these hospital records which have already been ordered (or re-ordered if they didn't get them). But I'm going to be very pushy about this and won't let them just brush this off like it's nothing until I have the right labs that prove it to be no big deal. Once they get these records, which we are hoping is Monday or Tuesday, then I will get a referral so I can get this further testing done.
I will keep you and everyone updated.
Thanks for linking me to those resources. I've contacted my insurance company and basically we do have to wait until my PCP reviews these hospital records which have already been ordered (or re-ordered if they didn't get them). But I'm going to be very pushy about this and won't let them just brush this off like it's nothing until I have the right labs that prove it to be no big deal. Once they get these records, which we are hoping is Monday or Tuesday, then I will get a referral so I can get this further testing done.
I will keep you and everyone updated.
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