Does Ulcerative Colitis Affect Immunoglobulin Levels and Cancer Risk?

Does ulcerative colitis have an impact?

Hello Doctor, I am a patient with ulcerative colitis, which is currently under control.
A colonoscopy in May showed that my mucosa has almost healed.
Recently, due to immune-related issues, my blood test showed positive cold agglutinins with IgM (1+).
I would like to know if this value could be related to my ulcerative colitis.
Additionally, I previously mentioned that I have been experiencing some lower back pain and am concerned about multiple myeloma.
I found information stating that this condition usually leads to an increase in immunoglobulins.
According to my blood test results from June 26, my albumin is 4.5 and globulin is 2.1.
Furthermore, my IgA on July 5 was 158 and Total IgE was 40, all within the normal range.
Can these results reduce the likelihood of multiple myeloma?

Cheng, 40~49 year old female. Ask Date: 2023/07/13

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
The likelihood of ulcerative colitis being associated with cryoglobulinemia is quite low.
Although there are sporadic case reports, I am somewhat skeptical about the correlation between these two conditions; generally, the chances are minimal, and I recommend monitoring.
As for multiple myeloma, laboratory findings often show an increase in globulins relative to albumin, so based on your test results, I believe it is unlikely.
This is from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, looking out for you.

Reply Date: 2023/07/13

More Info

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that primarily affects the colon and rectum. It is characterized by inflammation and ulceration of the colonic mucosa, leading to various symptoms such as abdominal pain, diarrhea, and rectal bleeding. Given your concerns regarding immunoglobulin levels and the potential risk of cancer, let's delve into these topics.

Firstly, regarding your positive IgM (1+) result, it is important to understand that immunoglobulin levels can be influenced by various factors, including underlying conditions like ulcerative colitis. In patients with UC, the immune system is often activated due to the chronic inflammation present in the intestines. This immune activation can lead to alterations in immunoglobulin levels, including IgM. However, a positive IgM alone does not necessarily indicate a direct correlation with ulcerative colitis or suggest a specific diagnosis. It is also worth noting that elevated IgM levels can occur in various conditions, including infections and autoimmune diseases.

As for your concern about multiple myeloma, it is crucial to interpret your laboratory results in context. Multiple myeloma is a type of blood cancer that arises from plasma cells in the bone marrow and is characterized by the overproduction of abnormal immunoglobulins. In your case, the laboratory findings you provided show that your albumin level is within the normal range (4.5 g/dL), while your globulin level is slightly low (2.1 g/dL). Additionally, your IgA and total IgE levels are also within the standard range. These findings suggest that there is no significant elevation in immunoglobulin levels that would typically be associated with multiple myeloma.

In general, multiple myeloma is often suspected when there is a significant increase in monoclonal proteins (M-proteins) in the serum, along with other clinical symptoms such as bone pain, anemia, and renal impairment. The presence of back pain can be concerning, but it is essential to consider other potential causes, such as musculoskeletal issues or inflammatory conditions, rather than jumping to the conclusion of multiple myeloma.

Regarding the cancer risk associated with ulcerative colitis, it is well-established that patients with long-standing UC have an increased risk of colorectal cancer, particularly after 8-10 years of disease duration. The risk is related to the extent and duration of inflammation in the colon. Regular surveillance colonoscopy is recommended for patients with UC to monitor for dysplasia or early signs of cancer.

In summary, while ulcerative colitis can affect immunoglobulin levels due to immune system activation, your current lab results do not indicate a high likelihood of multiple myeloma. It is essential to continue monitoring your condition with your healthcare provider and discuss any new or concerning symptoms. Regular follow-ups and appropriate screenings are crucial for managing ulcerative colitis and assessing cancer risk. If you have further concerns or symptoms, please consult your physician for personalized advice and management.

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