Hello, My Mother Already Has Osteoporosis And A Fatty Liver,

Posted on Fri, 14 Aug 2020

Question: Hello,

My mother already has osteoporosis and a fatty liver, and high blood pressure. She's 66. She's under control having regular blood tests etc and using medicine for these. She is also overweight. She does not have anemia and kidney tests on blood came normal a few weeks ago.

Here is her recent blood and urine test results for hematology and I am afraid that she has multiple myeloma. Please help me by looking at these results. Thanks in advance.

Blood:

Total Protein 8.30 (6-8.3)
Albumin 4.02 (3.5-5.2)
IgA 553.1 (70-400)
lgG 1895.5 (700-1600)
lgM 134.40 (40-230)

A/G Ratio 0.86
Albumin% 46.3 (52-65.1)
Alfa 1% 1.4 (1-3)
Alfa 2% 12.4 (9.5-14.4)
Beta 1% 7.4 (6.0-9.8)
Beta 2% 11.6 (2.6-5.8)
Gamma% 20.9 (10.7-20.3)
It says suspicious sharp band in the gamma region has been observed. I have attached the SPEP image. Does it show anything monoclonal or polyclonal? https://hizliresim.com/SJwXIs

Free Lambda Light Chain 48.5 (8.3-27)
Free Kappa Light Chain 33.1 (6.7-22.4)
Kappa/Lambda Ratio 0.7 (0.26-1.65)

Urine:

Total Urine Analysis
Blood (Hb) Negative
Bilirubin Negative
Urobilinogen Negative
Keton Negative
Glucose Negative
Protein 30 mg/dl (0-15)
Nitrit Negatif
Leukocyte Esterase ++
pH 5.5 (5-7.5)
Density 1045 (1010-1030)
Color Dark
Appearance Clear
RBC 12 (0-5)
WBC 11 (0-5)
Flat epithelium 13 (0-8)
Kidney epithelium 3 (0-2)
Hyalen Cylinder 3 (0-2)
Urea (spot) 3339.41 mg/dL (282-3486)
Creatinine (spot) 334.36 mg/dL (15-278)
Protein (spot) 35.90 mg/dL (1-14)
Protein/Creatinine 0.11 (0-0.2)

Answered by Dr. Shailja Puri (1 hour later)

Brief Answer:
Possibility of polyclonal gammopathy. Advised urine culture and BP control

Detailed Answer:
Hello,
Thanks for posting your query on Ask a Doctor forum.
I have gone through all the lab results as well as serum electrophoresis graph.
The abnormal findings are raised Ig G, raised lambda and kappa light chains, however, the ratio of light chains is within range.
A normal kappa to lambda ratio rules out monoclonal disorder, and there is higher possibility of polyclonal disorder like chronic inflammation.
However, I suggest you to take up few more investigations namely - serum immunofixation and beta 2 microglobulin.
Urine findings show an increase in pus cells / white blood cells and elevated leukocyte esterase.
These findings are suggestive of urinary tract infection, thus an urine culture and antibiotic sensitivity needs to be done.
There is an increase in urine protein and creatinine.
Since, there is history of hypertension, there is a possibility that hypertension is affecting the kidney functions.
The blood pressure (BP) needs to be controlled by medication and life style modifications.
Urine protein, creatinine and ratio needs to be monitored regularly.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Shailja Puri (3 hours later)

Thank you. Can you see a M-spike in her serum electrophoresis graph? What they wrote made me confused.

Answered by Dr. Shailja Puri (47 minutes later)

Brief Answer:
M band is not present on graph

Detailed Answer:
Hello and welcome again,
The comment in your report mentions a 'sharp suspicious band' in gamma region but it is not described as 'M band'.
M band is caused by elevated monoclonal protein or neoplastic protein.
To make picture more clear, I have advised immunofixation and beta microglobulin.
However, the results do not suggest Multiple Myeloma.

Thanks and take care
Dr Shailja Puri

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Raju A.T