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What Does My Celiac Panel Blood Test Report Indicate?

Posted on Fri, 17 Feb 2017

Question: Hello Doctor,

I would like a second opinion on something. I recently had
some lab tests done. One of them was a Celiac Panel which
included the (general) serum IGA test. Came back negative
for Celiac, but the IGA level was slightly above normal(ie.
474 and the cutoff is 452). My doctor said it's nothing to
worry about, but later on I talked to my brother who has
MGUS(pre-cancerous condition possibly leading to Multiple Myeloma).
He said this value can be elevated in this condition. And that
it's associated with kidney problems. I noticed my latest kidney
function tests, while not too bad, showed a decline(eg. EGFR reduced
from 113 to 101, Creatinine increased from 0.7 to 0.8, BUN increased a bit,
and some protein in the urine). Attached are my lab results showing all
this.

My question is: do you think a further workup for MGUS/Multiple Myeloma
is warranted given all the above? Again, my doctor feels its nothing to worry
about, but given my family history, slightly high IGA, and slightly worsening
kidney test results, I'm not so sure at this point.

Thank you very much!

Best regards,
XXXXXXX

Answered by Dr. Shailja Puri (25 minutes later)

Brief Answer:
Mild elevation of Ig A is not conclusive for MGUS, but SPE may be done.

Detailed Answer:
Hello,

Ig A for celiac disease is usually done in conjuction with serum Ig A levels. This is because of the fact that in cases of congenital deficiency of Ig A, the value of Ig A for celiac disease may be falsely low or absent. Thus, serum Ig A acts as a natural control in case of low Ig A against celiac disease.

Elevation of Ig A is only marginal high so nothing to worry about. I wouldn't conclude MGUS. However, I suggest you to get serum protein electrophoresis (SPE) prophylactically to rule out any plasma cell disorder.

Creatinine and BUN levels are elevated marginally as mentioned by you; but the numbers are still normal. I suggest you to get creatinine and BUN repeated after rest and after good hydration.
Presence of protein in urine is abnormal.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shailja Puri (46 minutes later)

Hello again, and thank you for that quick reply.
One followup question: if necessary, would you
be willing to write an order for this test(the SPE)
and possibly the kidney tests? And do you know
if these test orders would be honored by most
medical facilities here in the US? The reason
I'm asking for this is because I am part of
a government run healthcare organization(ie.
the Veteran's Administration), and they have
a pattern of not always providing the most
thorough health care. So I might have some
difficulty getting an order for this test.

Thanks so much,
XXXXXXX

Answered by Dr. Shailja Puri (34 minutes later)

Brief Answer:
I think you'd require a precription for SPE and KFT from your doctor.

Detailed Answer:
Hello and welcome again,

Although I am not well versed with norms in your country but I think that you would require prescription for getting both serum protein electrophoresis and kidney function tests (KFT) done.

So, I'd suggest that you should consult your healthcare provider.

Please feel free to get back in case of any further queries.

Thanks and take care
Dr Shailja Puri

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

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

Thanks - I understand.
In that case, before I push to have this test
done, can I ask you: if you were my doctor,
given my family history and lab results, would
you order the SPE and KFT tests even if I
didn't request them(ie. do you think this
is truly warranted)?

A final question, which there may not be an
answer to: assuming I did have MGUS(now or
at some later date), is there anything I can
do to reduce the chances of it progressing
to Multiple Myeloma, or at least slow down
the progression?

Thanks so much for all your assistance!

Take care,
XXXXXXX

Answered by Dr. Shailja Puri (12 hours later)

Brief Answer:
Requirement of SPE is mainly to clear your doubt.

Detailed Answer:
Hello and welcome again,
Your lab reports do not suggest anything serious.
However, a family history of MGUS or more importantly your fear of disease make me suggest this test to you.
However, your health provider is in better position to prescribe or not to prescribe you the test depending on your clinical features.

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. Remy Koshy