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Prostatis, GERD, carpal tunnel syndrome, arthritis, electrophoresis negative for multiple myeloma - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   Hello A few months back Free kappa light chains were observed in a 24hour urine test. I followed up with a hematologist and he performed the following tests: cbc, reticulocyte count, immunoglobulin quantification/Protein electrophoresis and FLC measurement. When i followed up with him in April he reported that my test results were He followed up with my family doctor and explained the my hemoglobin was 146, leucocyte count was 6.1, platelet count was 276. My protein electrophoresis was unremarkable and i do not have evidence of paraprotein in my urine. He did note however that I have an increased free kappa though in my blood with a kappa/lambda ratio of 4. He continued by saying that he does not know what to make of my increased free light chains. He states that I am clinically well. I have had a normal MRI of my spine and there was no evidence of lytic lesions. I have also had an MRI of my skull and all is normal. My renal function is entirely normal. With this in mind, my hematologist explained that he is really hesitant to go on and do a bone marrow. He is going to repeat my blood work and see me back in June for follow up. What could be causing this increase? I have been diagnosed with prostattis, suffer from GERD and acid reflux, have an ulcer and have carpal tunnel. I also had an x-ray on my knee and it showed arthritis. Could any of these conditions be affecting this increase?
I will also provide you with my immunogloblin levels- IGG- 10.3 g/L, IGA 1.95 g/l, IGM 2.04 g/L. My hematologist said these were perfectly normal.
He think he has pretty much ruled out multiple myeloma.
Could this increase therefore be polyclonal?
Doctor :   Hi
Doctor :   Give me few minutes to go through your query
User :   Hello Doctor, I hope you can shed some light for me. I have been very stressed out and worried.
Doctor :   Did your doctor mention about M protein of M band in electrophoresis report ?
User :   yes, i do not have any M protein.
Doctor :   Good. then your doctor is right in ruling out Multiple Myeloma
Doctor :   What is your age and gender ?
User :   I am 41 and it is my actually my husband that is going through this.He is a male of Italian background
User :   he is 41
Doctor :   Ok
User :   My creatinine level is also normal 84 umol/L, my albumin 45 g/L and my calcium 2.34 mmol/L
Doctor :   Ok
Doctor :   All the values are in the normal limits
User :   Could this increase therefore be a cause of any of my current health conditions? Could kappa light chains increase with sign of infection or inflammation?
Doctor :   Yes, increase in light chains is mostly due to chronic infections
User :   ok but only my kappa light chains showed an elevation because the ratio was 4:1
Doctor :   Basically light chains are produce by B cells
Doctor :   There are monoclonal cells
User :   What are monoclonal cells, kappa light chains?
Doctor :   They are cells that produce kappa light chains
Doctor :   During infection
Doctor :   when these cells are stimulated
User :   Ok are these then produces to fight infection? could my body be responding to this?
Doctor :   they multiply and produce increase quantity of light chains
Doctor :   Yes, that's right
User :   one oncologist told me not to get fixated on a slightly abnormal increase. Is 4:1 significantly higher?
Doctor :   Lets not put our belief in just a single time detected increase
Doctor :   It could be due to lab error
Doctor :   So I suggest get a repeat test is done
User :   ok my hematologist is going to retest in June. I hope you are right.
Doctor :   That's good
User :   If there is still an increase how will they determine if it is polyclonal
Doctor :   By electrophoresis method
User :   ok so because my electrophoresis is currently negative of M protein, is it most likely a polyclonal increase?
Doctor :   Let me explain
User :   ok thank you
Doctor :   As the term implies
Doctor :   Mono means One
Doctor :   Poly means many
Doctor :   Clonal means a single clone of cells
Doctor :   So during infection
Doctor :   If only one clone cells is stimulated it will cause monoclonal increase in light chains
Doctor :   If many clone cells is stimulated it will cause polyclonal increase in light chains
Doctor :   This will be detected in the elctrophoresis
User :   Ok but i thought monoclonal is associated with cancer and cell disease
Doctor :   Depending on the electro-chemical-mechanical gradient of these chains
Doctor :   Will be identified in electrophoresis
User :   ok so currently my electrophoresis reads . g/L. What does this mean?
Doctor :   g/L is the unit of measurement it means nothing. There should be a number before it
User :   yes but there was not. My hematologist said there was not any M protein.
Doctor :   Then he is right. It should have been nil. So they wouldn't have mentioned it
User :   there was nothing noted. so i don't understand. My blood work is completely normal. Why the increase?
Doctor :   Mostly lab error
User :   ok is my ratio alarming?
Doctor :   As all the tests are normal other than one
Doctor :   I think its a lab error and would put much weightage on it
Doctor :   Lets be patient till repeat test are done
User :   ok thank you. Is there anything i should ask my hematologist at my next visit?
Doctor :   Just get back to us with the report
Doctor :   We will discuss it in detail
User :   i did read that immunoassays can overestimate. Is this common?
Doctor :   That happens when the control settings changed

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