Elevated γ-globulin levels?
Hello, doctor.
Previously, I was concerned about the possibility of having multiple myeloma.
Later, I received some blood test results: FLC Lambda 11.89 (5.71-26.3) / FLC Kappa 14.45 (3.3-19.4) / FLC K/L 1.22 (0.25-1.65).
The Kappa level of 14.45 (3.3-19.4) seems to be on the higher side.
Additionally, my β2-microglobulin level is 1009 (0-2366).
The protein electrophoresis analysis shows γ-globulin at 1.8 g/dL (23.8%) with reference values of [0.5][1.8], β-globulin at 1.0 (13.9%) [0.3][1.4], α2-globulin at 0.6 (7.9%) [0.3][1], α1-globulin at 0.3 (4.1%) [0.1][0.4], total protein at 7.4 [6.4][8.3], albumin at 3.7 (50.3%) [3.5][5.5], and A/G ratio at 1.01.
The comment states: "Borderline increase of gamma globulin concentration, need clinical correlation for its significance." My total LDH is 169.0 [135][260].
Additionally, I have tested LDH1-LDH5: LDH1 25.7 (24.6-29.8), LDH2 34.6 (31.8-35.8), LDH3 19.8 (low) (20-24.8), LDH4 9.3 (6.8-10.2), LDH5 10.6 (high) (6.5-9.7).
It appears that my γ-globulin is elevated.
Does this indicate that I have multiple myeloma? Or could the elevated γ-globulin be related to my cryoglobulinemia with positive antibodies (IgM1+), or possibly related to ulcerative colitis? Or is it associated with RF+ 14?
Guang, 40~49 year old female. Ask Date: 2023/07/14
Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question.
Here are my responses:
1.
It appears that your γ-globulin levels are elevated.
Does this mean I have multiple myeloma? --> No.
Infections or autoimmune diseases can also cause a slight increase.
The manifestations of multiple myeloma are different.
2.
Could this elevated γ-globulin be related to my positive cryoglobulinemia antibodies (IgM1+), or possibly related to ulcerative colitis, or even related to RF+ 14? --> As mentioned above, inflammatory diseases can also cause elevated γ-globulin levels.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.
Reply Date: 2023/07/14
More Info
Elevated gamma-globulin levels can be indicative of various underlying health conditions, and understanding the implications of these results is crucial for proper diagnosis and management. Gamma-globulins are a class of proteins in the blood that include antibodies, which play a vital role in the immune response. When levels are elevated, it can suggest an ongoing immune response or other pathological processes.
In your case, the reported gamma-globulin level of 1.8 g/dL, which is at the upper limit of normal, may not be immediately alarming but does warrant further investigation, especially in the context of your concerns regarding multiple myeloma (MM) and other conditions. Multiple myeloma is characterized by the proliferation of abnormal plasma cells in the bone marrow, leading to increased production of monoclonal immunoglobulins. However, your free light chain (FLC) ratios and levels, particularly the kappa and lambda light chains, appear to be within a range that does not definitively indicate multiple myeloma. The kappa/lambda ratio of 1.22 is also within the normal range, which is typically between 0.26 and 1.65.
The presence of elevated beta-2 microglobulin (1009, with a reference range of 0-2366) can be associated with various conditions, including renal impairment and hematological malignancies, but it is not specific to multiple myeloma. It is important to correlate these findings with clinical symptoms and possibly further imaging studies or bone marrow biopsy if indicated.
You also mentioned having cold agglutinin disease (IgM1+) and ulcerative colitis, both of which can contribute to elevated gamma-globulin levels. Cold agglutinin disease is an autoimmune condition where the body produces antibodies that can lead to hemolysis, and this immune response can elevate gamma-globulin levels. Ulcerative colitis, being an inflammatory bowel disease, can also lead to increased immunoglobulin production as part of the body's response to inflammation.
Rheumatoid factor (RF) positivity (RF+ 14) could suggest an autoimmune process, which may also contribute to elevated gamma-globulin levels. Conditions like rheumatoid arthritis can lead to increased levels of immunoglobulins as the immune system is activated.
In summary, while your elevated gamma-globulin levels and other laboratory findings raise some concerns, they do not definitively indicate multiple myeloma. The context of your overall health, symptoms, and additional diagnostic tests will be critical in determining the underlying cause of these laboratory abnormalities. It is advisable to discuss these results with your healthcare provider, who may recommend further testing, including imaging studies or a bone marrow biopsy, to clarify the diagnosis and guide treatment options. Regular monitoring and a comprehensive approach to your health, considering all underlying conditions, will be essential in managing your situation effectively.
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