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Loss of appetite and fever. Diagnosed with urinary tract infection, given antibiotics. Serum protein electrophoresis showed bands in gamma region

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my father (age - 72) has been suffering from loss of appetite since the last one month along with mild fever. he was admitted to a local hospital where he was diagnosed with urinary tract infection and was administered antibiotics.
He was released from hospital last friday but is still unable to eat and is under constant nausea even with/without food.
serum protein electrophoresis results shows the presence of two bands in the gamma region. This was done as suggested by the doctor.
Please suggest way ahead. Thanks, XXXXXXX
Posted Wed, 22 May 2013 in General Health
 
 
Answered by Dr. Rohan Khandelwal 11 minutes later
Dear Ma'am,

Sorry to hear about your father's problem. The nausea and inability of eat can be due to the effect of antibiotics and the infection and will subside with time. You should give him small, frequent meals instead of the standard 3 meals. Also encourage him to drink more water.

The two bands in the gamma region require more investigation. Although it can be a normal finding in 10% of elderly patients but it can also be present in some immunological conditions. It is better than you get an ESR & peripheral smear done and review with an XXXXXXX medicine specialist.
Is he having backache as well?

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Loss of appetite and fever. Diagnosed with urinary tract infection, given antibiotics. Serum protein electrophoresis showed bands in gamma region 1 hour later
Thanks for the quick response. The antibiotics have been stopped since Friday and all that he is being administered currently is Festal N, Esoz-D, Herbolax, Benitec A, Betonin syrup, Seroflo 250 and Duolin.
We did try the small meal option but the fact is that he is having a vomiting tendency even when he is not taking any food.
Also there is no bowel movement in last three days. also he is complaining of extreme lower back pain.
The findings are as below -
13.04.13 - ESR count - 110 , HB - 10
15.04.13 - ESR count - 120 , HB - 9.1
TC - 16.2
15.04.13 - USG Whole Abdomen
: Multiple Cortical Cysts in both kidneys.kidney sizes are normal
16.04.13 - Creatinine - 2.6
Urea - 46
Potassium - 3.7
16.04.13 LFT - All parameters are in normal range

18.04.13
TIBC : 169.2
IRON Saturation : 27.12
Serum IRON : 45.9

19.04.13 - Serum total proteins - 7.60
Serum Albumin - 3.09
alplha 1 globulin - 0.71
Alpha 2 Globulin - 1.06
Beta 1 Globulin - 0.40
Beta 2 Globulin - 0.71
Gamma Globulin - 1.63
Albumin : Globulin Ration - 0.69

Many thanks and regards , waiting for your valuable suggestions.

Mr XXXXXXX XXXXXXX


 
 
Answered by Dr. Rohan Khandelwal 9 minutes later
Dear Ma'am,

Thank you for sharing these reports with me. His ESR is very high and this along with the additional gamma band, is an indicator of either multiple myeloma or MGUS. Both are types of blood cancers but the good thing is that they respond very well to chemotherapy. I dont mean to scare you but these conditions need to be ruled out by a peripheral smear and a back pain can be explained because of these conditions. Non passage of stools can be due to the constipation caused by lack of eating and the antibiotics. Once he passes stools, he will feel better and start eating little bit.
You can try cremaffin syrup (it is a laxative which will help him pass stools). Two tsf at night time.

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Loss of appetite and fever. Diagnosed with urinary tract infection, given antibiotics. Serum protein electrophoresis showed bands in gamma region 31 hours later
Latest reports as on 25.04.13 -

Urea: 130
Creatinine: 5.9
Uric Acid: 8.3Sodium: 131
HB: 7.4
TC: 19.6
ESR: 138

Regards, XXXXXXX
 
 
Answered by Dr. Rohan Khandelwal 17 minutes later
Dear ma'am,

Thank you for sharing the latest reports. From these it appears that his kidneys are not functioning properly. He requires urgent admission and consultation with an XXXXXXX medicine doctor and a nephrologist.
His wbc counts are also raised, which suggests an underlying infection. You should get him admitted without any delay.

Hoping for the best.
Above answer was peer-reviewed by
 
Follow-up: Loss of appetite and fever. Diagnosed with urinary tract infection, given antibiotics. Serum protein electrophoresis showed bands in gamma region 6 days later
Hi,

I have shifted my father to a reputed hospital on the 26th where he is currently being administered dialysis considering that he has suffered from chronic renal failure. His creatinine had shot upto 8.9 on the 27th and urea to 184. Till date, he has been given 3 sessions of dialysis and is being kept under monitoring. He is expected to have another round of dialysis before the blood samples are tested again.

Meanwhile the bone marrow test results are as below -
myelocytes - 13.0 %
metamyelocytes - 14.0 %
neutrophils - 40.0 %
eosinophils - 1.0 %
lymphocytes - 12.0 %
plasma cells - 10.0 %
normoblasts - 10.0 %

Comments -
the bone marrow aspirates show normocellular particles and cell trails.
Erythropoiesis is normoblastic in maturation.
Myelopoiesis shows allstages of maturation.
Lymphocytes are normal.
There is diffuse plasmocytosis constituted by plasma blasts, intermediate binucleate and mature plasma cells.
Megakaryocytes are adequate.

Impression - Myeloma marrow
Please correlate with serum electrophoresis findings


And the serum immunofixation report result is -

"high resolution serum protein electrophoresis reveals the presence of a monoclonal gammopathy (M spike) in gamma globulin region.
A 2nd protein band distal to it also in gamma globulin region could be isomer of the same."

This apart, the x-rays of the skull and the pelvic joints haven't revealed any specific abnormalities.

Please suggest what you make of the present condition. What is the recovery possibility of my father?

Thanks in advance.
XXXXXXX

 
 
Answered by Dr. Rohan Khandelwal 1 hour later
Dear ma'am,

Thank you for sharing the reports with me. I am glad that you rushed him to the hospital and got the treatment started on time. Dialysis will certainly help in improvement of his kidney function and his general health.
The underlying cause of the problem is in the blood. The report confirms what I wrote in the first answer, it suggests that he us suffering from a kind of a blood disorder (sort of a cancer)m which is leading to these problems.
You need to consult an hemato-oncologist in that hospital and ask him to start the required drugs for his disorder. Unfortunately this can only be done once his renal function and general condition improves.

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
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