Blood Test Results: Insights on Multiple Myeloma and Related Conditions

Blood test report issues?

Hello, doctor.
I was diagnosed with COVID-19 on June 10.
After that, on June 25, I developed petechiae on my calves due to an immune response.
I sought medical attention, and it was assessed as vasculitis.
I underwent blood tests and urinalysis, all of which were normal.
After taking steroids for one week, I recovered.
I followed up with a rheumatologist and had immune function tests done, including ANA, C3, C4, ESR, CRP, and A-DSDNA, all of which were normal.
However, I found that my RF IgM was 13.9 (0-6) and I had positive cold agglutinins IgM (1+).
Recently, I have occasionally experienced lower back pain and some muscle pain in my left calf.
An X-ray showed only mild degeneration.
Additionally, I have had discomfort related to cervical disc compression (as seen on MRI) from over five years ago, and I had another X-ray which also showed compression.
I do not have hepatitis B or C, but I am concerned and asked my doctor to perform tests for multiple myeloma.
My blood test results showed Beta-microglobulin at 1009 (0-2366), which is normal; FLC lambda at 11.89 (5.71-26.3), which is normal; FLC Kappa at 14.45 (3.3-19.4), which is normal; and FLC lambda/kappa ratio at 1.22, which is normal.
The protein electrophoresis analysis showed gamma-globulin at 1.8/23.8% (0.5-1.8), which is at the borderline; beta-globulin at 1.0/13.9% (0.3-1.4); alpha1-globulin at 0.3/4.1% (0.1-0.4); alpha2-globulin at 0.6/7.9% (0.3-1); and albumin at 3.7/50.3% (3.5-5.5%).
The PEP comment noted a borderline increase in gamma globulin concentration, requiring clinical correlation for its significance.
Additionally, LDH1-LDH5 showed that LDH5 was slightly elevated at 10.6 (6.5-9.7).
I have a history of ulcerative colitis, which I was diagnosed with last year, and my current symptoms and mucosa are under control.
Initially, I was treated with a low dose of steroids (for 5 months) and Pentasa.
I would like to ask if the increase in gamma-globulin indicates multiple myeloma or if it could be due to other factors.
Regarding the positive cold agglutinins IgM (1+), is this primary or secondary? Furthermore, I have read that there are three types: monoclonal, mixed, and polyclonal.
Which type does this fall under?

A-Zhe, 40~49 year old female. Ask Date: 2023/07/15

Dr. Hu Ziren reply Oncology

If the Beta-microglobulin and FLC ratio (kappa/lambda) are normal, the possibility of multiple myeloma can be ruled out.
Gamma globulin refers to immunoglobulins in the serum and is likely related to elevated RF IgM and cryoglobulin IgM levels.
Note: Considering the above values, it does not strongly resemble a hematological disorder, but rather suggests a rheumatological or autoimmune condition (such as rheumatoid arthritis).
Given the history of lower back pain and joint degeneration, it is recommended to consult a rheumatologist.

Reply Date: 2023/07/15

More Info

Understanding blood test results, especially in the context of potential conditions like multiple myeloma (MM), requires a careful analysis of various parameters and their clinical significance. Based on the information provided, let's break down your results and concerns.

1. Gamma Globulin Levels: Your gamma globulin level is reported as 1.8 g/dL, which is at the upper limit of the normal range (0.5-1.8 g/dL). This borderline increase can be indicative of several conditions, including chronic inflammation, autoimmune diseases, or plasma cell disorders such as multiple myeloma. However, it is essential to note that a slight elevation does not confirm a diagnosis of multiple myeloma. In many cases, elevated gamma globulin can be due to other factors, including infections or chronic inflammatory conditions.

2. Cold Agglutinin Positive IgM: The presence of cold agglutinin (IgM) can be associated with various conditions, including infections, autoimmune diseases, and lymphoproliferative disorders. The significance of a positive result depends on the clinical context. It is not specific to multiple myeloma and can occur in other conditions as well. The classification of whether it is primary or secondary depends on the underlying cause. If it is related to an identifiable condition (like an infection or autoimmune disease), it may be considered secondary.

3. Beta-Microglobulin and Free Light Chains (FLC): Your beta-microglobulin level is within the normal range, which is a positive sign as elevated levels can indicate increased tumor burden in multiple myeloma. The free light chain assay shows normal levels for both lambda and kappa chains, with a ratio that is also within the normal range. This is reassuring, as an abnormal ratio or elevated free light chains can be indicative of plasma cell dyscrasia.

4. LDH Levels: Your LDH (lactate dehydrogenase) level is slightly elevated at 10.6 (normal range 6.5-9.7). LDH can be elevated in various conditions, including hemolysis, tissue damage, and malignancies. While elevated LDH can be associated with multiple myeloma, it is not diagnostic on its own and should be interpreted in conjunction with other findings.

5. Clinical Correlation: The comment regarding the borderline increase in gamma globulin concentration suggests that further clinical correlation is necessary. This means that your healthcare provider will consider your symptoms, medical history, and possibly additional tests to determine the significance of these findings.

6. Next Steps: Given your history of ulcerative colitis and the recent symptoms you described (back pain, muscle pain), it is crucial to maintain open communication with your healthcare provider. They may recommend further testing, such as a bone marrow biopsy, if there is a clinical suspicion of multiple myeloma or other hematological disorders. This is the gold standard for diagnosing multiple myeloma, as it allows for direct examination of the bone marrow for abnormal plasma cells.

In summary, while some of your lab results may raise concerns, they do not definitively indicate multiple myeloma. It is essential to consider these results in the context of your overall health, symptoms, and medical history. Regular follow-ups with your healthcare provider and possibly a hematologist will help ensure that any potential issues are monitored and addressed appropriately. Remember, early detection and intervention are key in managing any health concerns effectively.

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