In mid-January I had a routine check-up, and I had my blood drawn for testing ahead of time.

On the day of my check up, I was running late, so, when I got to the cancer cen­ter, I just rushed up to the unit clerk’s desk to check in.  To my sur­prise, the clerk handed me a requisition for another blood draw, but with no tests specified.

Startled, I quickly went down to the lab area.  It turned out that I had signed up for a clinical study at the time of my stem cell transplant, and, because it was now the third year since then, I needed to provide additional blood for the routine annual checkup and experi­mental purposes.

The lab tech had to really dig around with the needle in both my arms, since my veins some time ago got smart and burrowed far down under the skin.  But she finally made a good connection, and soon nine little glass vials filled with my blood were lined up on a trolley.

Ever since my physicians first began to suspect that I have multiple myeloma, there has been very close and frequent monitoring of my blood.  I tell my friends outside of the myeloma world that I have the most tested blood of anyone they know.

I often think of each blood test as a detective of sort, reporting back to me and my physicians about my multiple myeloma, my myeloma treatments, and the impact the disease and treatments are having on my body.

There are a lot of detectives, and checking in on them has gotten a bit less comfortable for me, physically, over time.

For the first few months of my initial (induction) therapy, I had my blood drawn in the outpatient lab at our cancer center.  At that time, I also was getting intravenous injections of Velcade ^[1] (bortezomib), and my blood had to be tested on the day of treatment.  The nurses originally complimented me on my “good veins,” but myeloma treatments can be harsh on the system.  My veins started to shrink, making them harder and harder to find when a blood draw was needed.

My veins were saved from more damage when I had a central venous line (Hickman line) threaded into my chest prior to my stem cell transplant.  The line had three caps (lumens), and these were used for blood draws and stem cell collection as well as to give me hydration fluids, chemotherapy drugs, and, eventually, my stem cells.

The Hickman line was in place for about three months.  When it became clear that my transplant had been successful and my blood counts were normalizing, it was removed.

So, since March 2010, all of my blood tests have been done again by the lab technicians and their skillful use of needles.

What has been tested for in my blood, and why?

Initially, as I was first being diagnosed, the blood test “detectives” were used to determine how many of the so-called “CRAB” symptoms I had.  It was already clear from my fractured vertebrae that I had the “B” criterion, bone damage.  The blood tests were used to see whether I had any of the other three symptoms.

Calcium levels were checked to see whether I had hypercalcemia (excess calcium in the blood; the “C”).  Creatinine levels were checked to see whether I had any kidney damage (renal impairment; the “R”).  And hemoglobin (HGB) and hematocrit (HCT) levels were checked to see whether I had low red blood cell levels (anemia; the “A”).

Normal ranges for all tests are usually listed on the blood test results, and if a result is higher or lower than the norm, it is noted by an “H” or “L.”

I have learned over time to make clear the units used in blood test results when discussing them with myeloma patients in other countries.  In Canada, many results use units such as grams or milligrams per liter.  In the United States, the same tests often use units such as grams or milligrams per deciliter (one tenth of a liter).  Elsewhere in the world – and sometimes in Canada, as well – tests may use units such as micromoles per liter.

The other important “detective” that was employed during my initial diagnosis was the serum protein electrophoresis (SPEP) test.  It was used to determine whether my myeloma was creating excess protein in my blood and, if so, what sort of protein.

The SPEP test determined that I had high levels of the immunoglobulin protein IgG kappa.  This was the monoclonal protein level, or “M-spike,” that my physicians and I would then track during and after my treatment.  It’s a key test result because, for most myeloma patients, it reflects how many myeloma cells are in a patient’s body.

In the first few months after my diagnosis, I watched with amazement as the total protein and IgG kappa levels in my blood fell dramatically after I started my induction therapy.

My other blood values stayed in the normal range during the induction therapy.  This changed, however, immediately before, during, and after my stem cell transplant.  At that point, we had to start watching other blood test results very carefully.

During my stem cell collection and the high-dose chemotherapy before my transplant, my white blood cells, neutrophils, lymphocytes, and platelets all fell below normal levels.  After the stem cell transplant, all my blood cell counts fell pretty well across the board as my bone marrow had to start fresh and make new blood cells.

After 100 days of rest following the transplant, my blood counts were all in the normal ranges again.  How­ever, my SPEP test was still showing elevated levels of IgG kappa in my blood, so I started treatment with Revlimid ^[2] (lenalidomide).

Once again, my doctors and I had to watch my blood test results carefully, and not just to keep track of my M-spike.  Revlimid often causes blood cell counts to drop, and, sure enough, I experienced low neutrophil and white blood cell counts and sometimes had to delay treatment in order for my counts to recover.

Eventually I was on the lowest dose of Revlimid, and I stopped taking it after 12 months.  By that time, my SPEP tests revealed I was in complete remission.

Now, two years after being off of any treatment, my blood is healthy according to all the “detectives.”  I still scan my test results anxiously, but so far have been lucky.

I should add that, since I was diagnosed, a new “detective” has become available – the serum free light chain (FLC) test – which is a substitute of sorts for the SPEP test.  It can detect even very low levels of the kappa and lamba parts of immunoglobulin molecules.  For someone such as myself, whose myeloma resulted in high levels of IgG kappa in the blood, it is important to track both the total kappa levels in the FLC results as well as the kappa/lamba ratio.

Thank goodness for all of the blood tests used to check on our blood’s health and, indirectly, the health of our bone marrow.

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The quotation for this month is from Albert Einstein (1879 -1955), a theoretical physicist and humanist, who wrote “Look deep into nature and then you will understand everything better.”