What does my blood reports taken for fever, sleeplessness and body pain indicate?

Question

Hi doctor,

I am writing this letter for my mother-in-law. She is 65-years-old and seems to be healthy. She recently suffered from fever, sleeplessness at night, and body pain and thus visited a doctor (physician). After a physical examination and studying certain blood tests (that he was suggested to test), the physician advised us to consult with a hematologist as soon as possible. Soon, we consulted with a hematologist. He advised us to check certain tests such as protein electrophoresis and free light chain, hemoglobin test, liver test, and ultrasound of the abdomen and pelvis. He also pointed out that she may undergo a bone marrow examination subject to test results. The reports are as follows. We shall see the hematologist by next week. Before meeting him, we wish to know an expert opinion about interpreting the test results and further course of action.

The results are:

HbA1c- 6.65.
Bilirubin- 1.5.
Bilirubin direct- 1.
SGOT-54.
SGPT-30.
Alkaline phosphatase 04-304.
T protein- 7.1.
S. albumin- 3.8.
S. globulin- 3.3.
Calcium- 8.3.
Phosphorus- 3.
Uric acid- 6.1.
USG remarks: Chronic liver parenchymal disease with PHT, no ascites at present, other organs normal free kappa (light chain).
Serum– 46.
Free lambda (light chain) serum– 33.10.
Free kappa-lambda ratio– 1.39.
Total protein- 6.8.
Serum albumin– 3.7.
Alpha 1 globulin– 0.19.
Alpha2 globulin- 0.46.
Beta 1 globulin– 0.39.
Beta 2 globulin– 0.42.
Gamma globulin– 1.65.
Albumin-globulin ratio– 1.19.

Comments– electrophoresis shows elevated gamma globulin. No significant change in the other fractions. No M band seen. Kindly look into the above and revert with your valuable suggestions.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Your electrophoresis report shows an increased gamma globulin level (attachments removed for patient identity protection). So your doctor might suspect plasma cell dyscrasias, especially multiple myeloma-like conditions. Therefore referred you to a hematologist. But in the electrophoresis report, the M band is not seen, which is classically seen in plasma cell dyscrasia. Moreover, Kappa to Lamba chain ratio is normal in the report. So, the chance of multiple myeloma seems to be less.

But increased gamma globulin needs further workup in the form of CBC, serum calcium level, etc. In the case of multiple myeloma, the osteolytic bone lesion is also present. For that X-ray can be done in the suspected area. The gamma globulin increased in infection or inflammation as well. So your physical examination is necessary.

Moreover, your cirrhosis with portal hypertension needs treatment in the form of a beta blocker to reduce portal hypertension. The elevated bilirubin can be due to liver damage by cirrhosis.

Thank you for consulting me.

You can always come back and reach me at icliniq.com.

Answer 2

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

Below is the answer to your questions.

The chance of myeloma is less. But it cannot be excluded 100 % based on that report (attachment removed to protect patient identity). So although the chance is less, a very minor possibility should be kept in mind. Further investigations and physical examination are needed to exclude myeloma.
After a physical examination, your doctor feels that bone marrow might be suggested, which can exclude plasma cell dyscrasias by almost 100 %.
Sorry, she has chronic liver parenchyma disease. It can be a chronic hepatitis problem, as nodules have not been mentioned in the USG report. So it is not a cirrhosis case.
The chronic condition is not reversible, but it can be prevented from further progression (like cirrhosis) by regular screening of liver enzymes and a ultrasound scan. To decide the exact grading of liver disease biopsy can be done for a histopathology examination.

Thank you for consulting me.

You can always come back and reach me at icliniq.com.

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