Is emergency treatment necessary for my 70-year-old father with an increased globulin level?

Question

Hi doctor,

My father is a 70-year-old male with BPH and well-controlled type 2 diabetes. He has been fatigued for six weeks. He was found three weeks ago to have mild anemia (Hb-12 gm/dL) and macrocytosis with mildly low vitamin B12. He started vitamin B12, but had a slow progression of fatigue, and had further testing yesterday. This showed Hb at 10.5 gm/dL and Plt at 108,000 platelets/µL. The differential showed a single metamyelocyte and no blasts. He had slightly decreased renal function (I believe Cr 1.3 mg/dL, GFR around 50 mL/min/1.73 m2).

His total protein was 14.8 g/dL with albumin at 1.9 g/dL. Aside from fatigue, he had mild hypotension, resolving with discontinuation of the tablets Tamsulosin and Lisinopril. I am a family physician, and he was previously an ICU RN. Protein electrophoresis is pending, and he has a referral to a hematologist.

I believe he is likely to have multiple myeloma. I have never seen a globulin level approaching these numbers.

Currently, I am taking the tablets Metformin and Finasteride.

Are there potential immediate complications like hypercoagulability with such an elevated globulin level, and would the risk of those complications warrant emergency treatment?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The following is my opinion on your question.

We cannot say multiple myeloma conclusively just now. Impaired kidney function can also cause anemia, fatigue, and low platelet count. Diabetes could have produced such renal dysfunction. However, serum immunofixation electrophoresis will rule out plasma cell dyscrasia if present.

You can revert to the previous version once the report is complete. If there is no sign of a clot in the body, then do not worry. You can also check the D-dimer level to check for the microclot.

Meanwhile, I suggest taking a tablet of Aspirin 75 or 150 mg to prevent a clot. Advise him to walk daily for a few minutes. Geriatric old age and kidney dysfunction-induced anemia could occur because of fatigue. An increase in globulin does not warrant immediate clot formation. Inflammation can raise it, so wait for immunofixation electrophoresis.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.