[MrChris]

Immunofixation results with multiple sclerosis & Lyme

by MrChris on Wed Nov 16, 2016 10:48 am

Good day everyone,

My name is Chris, I am a 33 year old male residing in Canada. I have not been diagnosed with multiple myeloma but have been going through routine workups in which I'm getting no answers from my Doctors.

A brief history about me;

I was diagnosed with multiple sclerosis at the age of 30, as well as Lyme disease at age 31.

My treatment for multiple sclerosis does not include any immunosuppressants,and the treat­ment for Lyme consists of long-term antibiotic and anti-malaria drug usage which I seek from a doctor in the United States.

About 2 years ago, I switched neurologists to one that specializes in multiple sclerosis. During this transition, being the thorough doctor she is, she ordered some new lab tests that I have never had performed prior to. One of them is serum protein.

Although she did not order my cerebrospinal fluid (CSF) to be tested, I'd like to share it with you as it might provide a better painting to the bigger picture. It was because of the conclusive CSF analysis that definitive multiple sclerosis was confirmed.

December 2014:

Lumbar Puncture - during this time, I was experiencing an active relapse. My neurologist says consideration must be given to this factor for the high level of CSF protein.

CSF total volume 9.5
CSF appearance clear
CSF colour colourless
CSF supernat colourless
CSF WBC 28 (Hi)
CSF RBC 1
CSF Lyph 0.98
CSF Other cells 0.02
CSF path com; moderately cellular cytospin preparation containing lymphocytes, scattered plasma cells and monocytes. Rule out infection, inflammatory process, degenerative disorder, etc. Clinical correlation is required. Suggest flow cytometry if a lymphoproliferative disorder is suspected clinically.

CSF Glucose 3.2 n/mol
CSF protein 0.90 g/l (H) (ref range .12-.60)
CSF Albumin 0.52 g/l (H) (ref range 0.14-0.25)
CSF IGG 0.163HI g/l (ref range <0.059)
CSF Igg/Alb Rat 31% (H)
Alb INdex 12.4

IGG INdex 108 (H) (ref range 35-69)
Serum IGG 12.2 g/l

Pattern; Several bands of varying concentration seen in CSF (but not in serum) following IEF-IgG immunoblotting. Oligoclonal banding pattern, frequently seen in multiple sclerosis. Elevated albumin index is suggestive of increased permeability of the blood-brain barrier.
Culture report Negative
Microbiology;
Gram Stain- White blood cells present- no organisms seen

The first was an immunofixation of serum in May 2015:

Results; A faint ill-defined band of IgG, type kappa is detected. A faint ill-defined band of IgG type lamba is detected.
**Please submit another specimen in 6-12 months to confirm observation**

August 2015

IgA - 4.45 g/l (H)
IgG - 13.01 g/l
IgM - 0.75 g/l

Total protein - 77 g/l
Albumin 51g/l (H)
Aplha-1 - 2g/l
Aplha-2 - 6 g/l
Beta - 7g/l
Gamma - 11 g/l

Immunofixation-Serum
A faint ill-defined band of IgG type kappa is detected.
**Please submit another specimen for immunofixation in 6-12 months

October 2015

Creatine Kinase - 84 u/l
IGA - 4.47g/l (H)

ANA -Negative
RF-Serum 21 IU/ml (H) - I saw a rheumatologist about this, and he said it is insignificant
C Reactive protein <1mg/l

Deamidated Gliadin Igg Negative <0.5 u/ml
Tissue Transglutaminase Negative IgA <0.5

August 2016

IgA 4.53 g/l (H)
Total Protein 83g/l (H)
Albumin 51.3g/l (H)
Alpha Globulin 1 2.8g/l
Alpha Globulin 2 5.8 g/l
Beta 1 Globulin 5.0 g/l
Beta 2 Globulin 5.2 g/l (H)
Gamma Globulin 12.9 g/l

Imunofixation
Serum protein electrophoresis does not suggest a monoclonal pattern. Beta-gamma bringing is observed. This may be due to a diffuse increase in IgA. No monoclonal banding is detected in serum.

My hematocrit has always been on the lower side of the reference range and usually sits between 0.400 and 0.430.

I'm going to see my doctor again at the beginning of December, and I like to have as much knowledge as possible before I sit down with her. Anyone's input would be greatly appreciated.

Thanks

[Multibilly]

Re: Immunofixation results with multiple sclerosis & Lyme

by Multibilly on Wed Nov 16, 2016 7:36 pm

Hi Chris,

Welcome to the forum.

These are a lot of test results to digest. I'm also not a doc and I'm also not at all familiar with the impact of multiple sclerosis and Lyme disease on lab results. So, keep that in mind as your read this response.

From a myeloma standpoint, I think your last immunofixation test is the most revealing.

"Serum protein electrophoresis does not suggest a monoclonal pattern. Beta-gamma bringing (this is probably meant to say "BRIDGING", not "bringing"). This may be due to a diffuse increase in IgA. No monoclonal banding is detected in serum."

Your IgA level is somewhat elevated and that would account for your total protein also being high. But since the immuofixation test confirms that there is no monoclonal pattern, the elevated IgA must be polyclonal in nature (which helps rule out multiple myeloma). Polyclonal increases in IgA can be due to things such as hepatitis, liver cirrhosis, connective tissue diseases, and acute and chronic infections.

Also, my understanding is that beta-gamma bridging showing up on a serum protein electrophoresis can suggest liver disease. Liver disease can also lower one's hematocrit level. So I would be asking your doctor about the current health of your liver and going back and looking at your AST, ALP and ALT results on your most recent metabolic panel test.

Again, I'm not a doc, and I have no idea how your other conditions or drugs you are taking would impact these lab results, so please take all this with a grain of salt.