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MGUS I need help understanding my lab report.
Blood Cancers & Disorders | Last Active: Jan 20 9:58am | Replies (32)Comment receiving replies
@nsnipes11 , I'm going to take a crack at just listing the reference ranges with footnotes for the online sources for the immunoglobulin and kidney test results that you mentioned. I can't do much interpretation, not being qualified to do so. I hope it will help, though.
You wrote: "... immunofixation shows IgG monoclonal protein with lambda light chain." I'm listing the values you then reported with a reference (normal) range for each one.
The caveat is that different labs may use varying ranges for the same tests, depending on their processes. I think that the immunoglobulin values are probably (?) pretty standard, but I'm not sure about glucose, creatinine, and other blood values. I think that different labs might vary more on those. Anyway:
"< " means "less than".
">" means "greater than".
M-SPIKE
- M-spike = 1.5 mg/dL
--- Mayo Labs ref : IgG < 3 mg/dL may be consistent with MGUS or a number of other monoclonal gammopathies. *
--- IgG > 3 mg/dL is consistent with multiple myeloma. *
So your M-spike is square in the middle of the reference range for MGUS.
IMMUNOGLOBULIN G
- IgG = 1,819 mg/dL
--- Mayo Labs (normal) ref range: at age > or =18 years: 767-1,590 mg/dL *
--- --- So you have somewhat higher IGg than Mayo Labs' reference range. Other labs may state this range somewhat higher or lower. Problem is, I can't figure out what a "concerning" high level might be, as opposed to "slightly high". And the IgG level can go up for reasons other than MGUS, like a recent infection, autoimmune problems, and others.
KAPPA/LAMBDA RATIO
- K/L Ratio = 0.39
--- Mayo Labs ref range: 0.26-1.65 *
LAMBDA FLC
- Lambda FLC = 27.00 mg/dL
--- Mayo Labs ref range: 0.57-2.63 mg/dL *
KAPPA FLC
- Kappa FLC = 10.53 mg/dL, calculated below
--- --- kappa / .39 = 27.00
--- --- 10.53 / .39 = 27.00
--- --- kappa = 10.53
--- Mayo Labs ref range: 0.33-1.94 mg/dL *
The kappa/lambda RATIO is within the normal range, but the kappa and lambda measures are each above the normal range. It's my (limited) understanding that a variety of factors can cause both types of free light chains to increase at the same time, including the kidneys having trouble clearing them*, or your body making more in the first place, which can happen with infections, inflammation, or some autoimmune diseases*. Or both.
Since kidney health may impact free light chain values in blood, I'll include those values, too.
CREATININE
- Creatinine = 1.1 mg/dL
--- Normal, female (American Kidney Fund): 0.6 - 1.1 mg/dL
eGFR
- eGFR = 53
--- Average, age 70+: 75
According to the National Kidney Fund and a few other places I spotted, the creatinine result is within normal range for a female, though at the top, and the eGFR is kinda lower than normal. But eGFR scores decline over our lifetime, so at close to 80, this score may be low, but not extremely so. I don't know. That'll be a question for a doctor, maybe in relation to previous eGFR results.
Which leads to this: You, as an insured patient and heck! a human being! deserve professional answers to your health questions. All of them. I can understand the doctor getting sidetracked in an appointment, but I can't quite grant your healthcare team that tolerance for not answering your Portal questions. If it were me, I think I'd politely repeat the message every three days until someone answered. Or find a doctor who is responsive, maybe even someone in the same practice. My neuropathy problem alone is forcing me to pound some doors.
Best wishes! ❤️
Nancy
REFERENCES
* IgG reference range: https://www.mayocliniclabs.com/test-catalog/overview/8156#Clinical-and-Interpretive
* IgG ranges for MGUS/MM: https://www.mayocliniclabs.com/test-catalog/overview/609783#Clinical-and-Interpretive
* K/L ratio, lambda, kappa ranges: https://www.mayocliniclabs.com/api/sitecore/TestCatalog/DownloadTestCatalog?testId=609782
* Both lambda and kappa have raised levels: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253807/
* Creatinine: https://www.kidneyfund.org/all-about-kidneys/tests/serum-creatinine-test
* eGFR: https://www.kidney.org/atoz/content/gfr
Replies to "@nsnipes11 , I'm going to take a crack at just listing the reference ranges with footnotes..."
Nancy,
I can't thank you enough! This helps me quite a bit. I, too, have had bone marrow biopsies. One at the very beginning, and one by accident (when my records were confused with someone else). The biopsies both showed about 5% plasma cells. The last one was done in 2019.
A bit of explanation about my current doc. I had a very good hemo/onc that left after a couple of years to practice at Emory in Atlanta. I just stayed with the incoming doctor. She, too, is a hemo/onc. I've had MGUS for 10 years, so I'm pleased that I'm still in the MGUS category. About her bedside manners: For me, they aren't good. When I asked about pain in my hips (which I understand comes with myeloma), she questioned me whether or not I thought it was due to Myeloma. I said "no" since I also have osteoporosis and lumbar and cervical disk disease. I asked about a urinary issue, and she came back with the same thing. I decided not to question further, but I am more and more disenchanted with her. I hate to pull up roots and move to another doctor as I'm seeing a number of docs now, with most issues remaining stable. But ... if my numbers go up, and there is any question that my diagnosis is changing, I will change doctors.
Thank you so much for all the work you've done on my behalf! I haven't sorted through the information under References, but I will. I am still working two weeks out of the month, proofreading for an electric company, so once I've completed my work, I'll get back to this.
Again, Nancy, thank you! You are a blessing!
Nan
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@nsnipes11 (Nan), I just had another thought. It's quite possible that your primary care doctor just doesn't know much about the ins and outs of MGUS. It's pretty complicated when you consider that other factors like recent infections and kidney health can have an impact on MGUS markers. So I wonder if you could ask for a referral to a hematologist or hematologist/oncologist? That way you could get explanations and further care.
I've been a bit of a squeaky wheel, myself. I hate doing it because I worry that "they" will think I'm a neurotic pest, but - it's my freakin' body and I need to understand what's going on. I'm 72 and never had a weird chronic unexplained problem like neuropathy before. Plus fatigue and daily low fevers. So they ordered a shotgun bunch of labs and just one of them showed an abnormality - my free light chains RATIO had a high kappa. The kappa itself was only moderately above normal.
Long story short, I sent a slew of references to our Portal that showed why I was concerned about AL amyloidosis, and kept wangling my way into having those discussions with a different doctor than my Primary, because he was more responsive. So he went back to the hem/onc who had consulted with the first doctor and (I think) talked him into a fat and bone marrow biopsy. I didn't get to see or correspond with the hem/onc myself.
So - no amyloids there, but now I know more about my monoclonal plasma cell load (only 5%, so MGUS) and their particular mutation ("standard risk" for multiple myeloma, higher risk for AL amyloidosis and other light chain-related conditions).
Since I have no M-spike, the monoclonal plasma cell load couldn't be determined from a blood test. I think. So the information from the bone marrow biopsy is nice to have as a baseline.
Anyway, I'm arming myself for a meeting with my regular Primary tomorrow and need to ask more questions. A couple of blood tests were skipped, for instance, and I need to understand the rationale. It's such a drag to advocate for oneself, but... we gotta.
In your case, if you stick with this possibly MGUS-naive doctor, I'd push for an explanation of your kidney test values unless those have been relatively stable and have already been explained.
❤️
Nancy