What Does This Lab Report For Monoclonal Protein Disorders Indicate?

Posted on Thu, 30 Jun 2016

Question: Please, please help. I am being tested for monoclonal protein disorders like Multiple Myeloma, Waldenstrom Macroglobulinemia, MGUS, etc. I have received the attached results from serum protein electrophoresis and serum immunofixation. The immunofixation results indicated that they were abnormal, but no monoclonality was detected. Please help me understand what these results mean, I'm having incredible anxiety right now. If it's of any importance, I have had rabies vaccination within the past 5 months, which as I understand can lead to a polyclonal abnormality, but I don't know whether that is what has been detected or not. Please help!

Answered by Dr. Shailja Puri (1 hour later)

Brief Answer:
Acute inflammation can cause high Ig A.

Detailed Answer:
Hello and welcome to Health Care Magic,

I've gone through your reports and the good news is that you have no 'M band' or myeloma band.
This rules out multiple myeloma.

Elevated immunoglobulin band can occur in cases of acute inflammation.
Low immunoglobulin G can be repeated after few months.

The levels of both Ig A and Ig G are expected to come within normal range.
The acute inflammatory phase is expected to fade away after some time and normal Ig A and Ig G is expected.

You can relax for now.

Thanks and Take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Shailja Puri (41 minutes later)

Thank you so very much for your prompt response Doctor. I was initially unable to upload an actual copy of my lab report with the graph of serum electrophoresis results, but after modifying the file I was now able to, in case reviewing it would be of any use.

It's very good to know that no m-spike was detected in either blood panel but I do have a few quick follow up questions, if you don't mind:

1) Would it be correct to say that since the IgA was increased a bit above the reference range without monocolonal proteins detected that this would be called a polyclonal increase? Oligoclonal increase?

2) Per your comments about acute inflammation causing an increased IgA, I recently had my ESR and C-reactive protein tested (CRP report attached), and both were in the VERY low range, which I took to mean very little inflammation. ESR report is not attached, but was only 1mm/hour. Could the IgA increase still be attributed to inflammation in the presence of very low ESR and CRP? If not, is there any other cause of the elevated IgA/decreased IgG?

3) I am also having urine electrophoresis tested, but don't have the results back yet. Is there anything in these current lab results that might increase suspicion of a monoclonal protein on the urine test?

Thank you so much!!!!!

Answered by Dr. Shailja Puri (13 hours later)

Brief Answer:
Ig A may be raised due to other components besides acute phase reactants

Detailed Answer:
Hello and welcome again,
A normal CRP and ESR rules out acute inflammation.
However, besides acute inflammation there are other components in blood which can raise the Ig A levels like Thyroid binding globulin, alpha 1 trypsin etc.
However, the levels are not so high so as to indicate any alraming condition.
Ig G levels are low.
Low levels can occur in hypogammaglobulinemia, however, a repeat estimation is required since these changes may be temporary.
I would not label the condition as increased monoclonal protein and would like to review a repeat serum electrophoresis after couple of months.

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. Yogesh D