Patient's Query
Hi doctor,
I am seeking some clarification regarding hematological findings. A few years ago, it was discovered that I had kidney dysfunction. The first nephrologist I consulted ordered a serum protein electrophoresis (SPEP), noting that multiple myeloma can be a potential cause of kidney disease.
Since then, I have undergone three or four SPEP tests, and my immunoglobulin A (IgA) levels have been elevated each time. In addition, I have consistently shown elevated light chains, elevated beta-2 microglobulin, and elevated alpha-1 globulin. Despite these findings, I have not received a clear explanation for the abnormalities. They have generally been dismissed due to the absence of an "M spike" on electrophoresis.
My question is: Should these results be further investigated, or is the presence of an M spike the definitive criterion for pursuing a diagnosis such as multiple myeloma or related disorders?
I would greatly appreciate guidance on whether these persistent abnormalities warrant further hematological evaluation or if they can be considered clinically insignificant in the absence of an M spike.
Please help me.
Thanks.
Hello,
Welcome to icliniq.com.
I understand your concern.
Thank you for sharing your story and the concerns you have it is reasonable to want clarity, especially when laboratory tests keep showing abnormal results.
Here Is what is going on and some key points to consider:
In multiple myeloma and some other plasma cell disorders, there is a monoclonal spike (M spike) on serum protein electrophoresis (SPEP) or urine protein electrophoresis (UPEP). It represents a large quantity of one identical (monoclonal) antibody.
If there is no M spike, it usually means there is no large clonal expansion of plasma cells.
Elevated IgA: This can be due to chronic inflammation, liver disease, or monoclonal gammopathy of undetermined significance (MGUS) (a benign, but clonal plasma cell population).
Elevated free light chains (FLCs) can suggest plasma cell activity. In the absence of an M spike, light chain MGUS or a “smoldering” plasma cell disorder could be considered.
Beta-2 microglobulin: can rise in many conditions, including chronic inflammation, kidney dysfunction, and myeloma.
Alpha-1: This might be alpha-1 antitrypsin, which can be high in inflammation.
Is the m spike the be-all and end-all?
No, while an M spike is a classic marker for myeloma, it is not the only criterion for plasma cell disorders. There are light chain myeloma and non-secretory myeloma, which might not show an M spike but still have abnormal plasma cell activity in the marrow.
What to do next?
Given:
Persistent elevation of IgA and free light chains.
kidney disease.
elevated beta-2 microglobulin.
I hope this answer helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
Thank you very much for the prompt and thorough response. You covered a lot, even without many additional details, and I truly appreciate that.
What has brought this back to the forefront of my mind is that I have recently started experiencing deep, aching pain in my limbs. That has made me revisit these concerns more seriously. I also noticed that your previous message ended with "What to do next?" but did not go further, so I was not sure if there was more intended or if that was simply the conclusion.
At this point, I am not quite sure where to turn. When I search for hematologists in my area, most are listed as oncologists or affiliated with cancer centers. I do not see myself as a severely ill patient, and I would feel uncomfortable taking up a time slot that might be needed for someone facing a more urgent or life-threatening condition.
This leaves me uncertain about what to look for in a hematologist, how to approach the consultation, and what specific questions I should ask. The only physician who has taken my concerns seriously so far is my primary care provider; he re-ran the tests and recommended that I discuss the results further with a nephrologist.
Unfortunately, I had to change nephrologists. The first one dismissed my concerns, saying I was "too young" to have something like multiple myeloma, and assured me I was fine. I wanted to shake him and say, That is exactly why I am here. I should not have the same kidney function levels as my 66-year-old mother, who only has one kidney.
Thank you.
Hello,
Welcome back to icliniq.com.
Thank you for sharing more about how you are feeling and for describing the new symptoms you have developed. It is completely understandable to feel concerned and uncertain about the next steps. Let us go through your questions and concerns one by one, step by step.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
Well as mentioned, I would like to find the right doctor to dig in and help me figure out what has caused these labs to be elevated, but I do not know where to start.
Thank you.
Hello,
Welcome back to icliniq.com.
That is a really great and important next step! Let us break this down so you feel confident about how to find the right doctor to help you figure out what’s going on.
Thank you.
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Answered byDr. Akanksha Agarwal
Medically reviewed byiCliniq medical review team
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