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    What is the significance of IGA and IGM together?

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Posted on Sun, 15 Apr 2012 in Blood Disorders
Question: Hi, I have recently been diagnosed with MGUS. Although my IG levels are just above what would be considered normal. The oncologist/hematologist was only concerned with the elevated IGM, of 2.92 G/L, and not so concerned with the elevated IGA of 4.75 G/L. IGG is normal at 12.41 G/L. Also elevated was Beta 2 Globulins at 4.8 G/L, ESR of 25 mm/Hr, and Cellular Hemoglobin Retic of 32.4 PG.
My question is: What is the significance of IGA and IGM together? As I mentioned before My Oncologist only seemed concerned with the elevated IGM.
doctor
Answered by Dr. Robert Galamaga 3 hours later
Hello and thanks for your query.

Your question is a good one and I will try to provide you with some good information and recommendations regarding what is going on.

MGUS is part of a spectrum of disorders involving plasma cells which circulate in the body. These cells produce immunoglobulins. In some patients such as yourself, the production of immunoglobulins is mildly increased.

The reason why we refer to this as monoclonal gammopathy of undetermined significance is that some patients have this mildly elevated level and go on for many many years without developing any problems such as anemia, problems with kidney function or with bone density.

Along those lines we end up following the serum protein electrophoresis and immunofixation which gives us the levels of the immunoglobulins as you mentioned - IgM, IgA and IgG. Would it be possible for you to submit a complete report of the lab studies which you had performed? This would give me more information in context and the ability to comment on these numbers which you provided since every lab is unique and has it's own standards of normal lab values.

Let me tell you - as I wait for more information from you - that the labs are not life-threatening and this is more than likely something that will be followed closely over time and a decision regarding observation versus treatment is something your oncologist will decide as he or she reviews a serial picture of your protein levels.

I await your replay and additional information.

Sincerely,

Dr. Galamaga
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Robert Galamaga 2 hours later
Thank You Dr. XXXXXXX

I uploaded the three pages I have from the lab results. I hope you receive then well. I realize that this is not life threatening, however, I am curious with what is going on. The MGUS was found, as I understand it usually is, found by fluke. My lower back has been bothersome for 3 - 4 yrs. After X-Rays and blood tests they found I have Osteoporosis, Kidney Stones and MGUS. The calcium levels in my blood were normal, the calcium with the 24hr. urine were slightly elevated (sorry, I don't have those results)

I am looking forward to hearing from you.

Regards,
Kevin Walline
doctor
Answered by Dr. Robert Galamaga 10 hours later
Hi XXXXXXX

Thanks for the details.

I am not 100% convinced that this is a MGUS. The fact that you have two elevations - the IgA and IgM may place you in a category of a polyclonal gammopathy. We see polyclonal gammopathy in people who have underlying inflammatory conditions. I don't think the bone density is related to this nor are the kidney stones.

At this point close observation is the key to good followup and a repeat protein study should be performed within the next 3 months to document a trend if there is one in your overall protein profile.

Thank you again for submitting your query. I hope you found my answer to be both helpful and informative.

Regards,

Dr. Galamaga.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Robert Galamaga 1 hour later
Hi Dr. XXXXXXX

Thank You for this information.

I did a quick look on the internet to find out more information on polyclonal gammopathy. There is less information for this than MGUS. From the brief reading that I did, it suggests an underlying condition. I have also had a chronic cough and mild shortness of breath. The chest x-rays were normal and a breath test suggests possibly asthma. Could polyclonal gammopathy is related to that?
Typically, is the cause of polyclonal gammopathy something that is curable or treatable?

I am not due to see my Oncologist until December for a follow up. He only wanted to see me every six months. How do you suggest I move forward with this information.

I could see my Family Dr., he is very good, but had limited information with MGUS (assuming polyclonal gammopathy as well). I could request to see the Oncologist earlier, would this be something he would look at? What should I be asking for, i.e, specific blood tests?

Thank You again for your information, I'm sorry this led to more questions.

Regards,
Kevin Walline


doctor
Answered by Dr. Robert Galamaga 8 hours later
Hi,

Thank you for submitting your followup.

I don't think what is going on warrants a more immediate follow up with your oncologist. I would say maybe send him a letter or note and ask him if he thinks a polyclonal process would be a consideration. I think your family doctor would probably not be familiar with this and this is really beyond the scope of practice of a general doctor.

Asthma is an inflammatory process and could possibly explain what is going on. It is remotely possible still that this could be a monoclonal gammopathy so a follow-up blood test with protein levels is certainly indicated in six months is a reasonable time. If this is a polyclonal process it can sometimes resolved if the underlying illness is treated appropriately.

Again I thank you for your question and follow up. If you have any additional concerns regarding this I would be happy to address them.

Sincerely,

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

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