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Q. Can paraproteins fluctuate without treatment?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 07, 2016 and last reviewed on: Oct 09, 2018

Hello doctor,

Can paraproteins fluctuate (drop) without treatment?

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hi,

Welcome to icliniq.com.

We are here to help you.

  • Yes, the levels can vary. In fact the levels always fluctuate and hence never used as a marker of treatment response.

For further doubts consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Hello doctor,

It has dropped from 58.739 g/L to 48.739 g/L in six months, whereas before it was always in the 50s. Would it drop by such a large margin? Should I start the treatment now? What treatment has to be followed?

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hi,

Welcome back to icliniq.com.

  • Yes, this drop can happen and to comment on the treatment warranted, I need to see your serum protein electrophoresis report to see which gammopathy you are having. 
  • I also need to know your hemoglobin as well as kidney function tests.
  • Kindly mention why treatment has not been started yet.

Revert back with the asked details to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Hello doctor,

My test results are this way IgA - 0.166 g/L, IgM - 0.335 g/L, IgG - 48.738 g/L, B2 micrglobulin - 1.4, hemoglobin - 10.1 g/dL, RBC - 3.48, WBC - 3.57 and Hct - 29.9. Renal profile is all within range except for sodium a little under the lower limit. I just got my diagnosis 20 days back. I am about to discuss treatment with the hematologist tomorrow. Please guide.

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hi,

Welcome back to icliniq.com.

I have checked your test results that you have mentioned.

  • Elevation in immunoglobulin G (IgG) can occur due to chronic infections like hepatitis B, C and human immunodeficiency virus (HIV).
  • Also, it can occur in monoclonal gammopathies such as multiple myeloma, amyloidosis and monoclonal gammopathy of undetermined significance.
  • You would be further evaluated by various other tests by your doctor. 
  • If the diagnosis gets supported for multiple myeloma then you would need treatment for that. 
  • Otherwise, you would be evaluated for various infections and found would be treated.

For further clarifications consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Hi doctor,

I was diagnosed with multiple myeloma because of the presence and level of the monoclonal protein and two lytic lesions and also a kappa/lambda ratio of 0.19 using the nephelometric immunoassay latex enhanced method. I just need a second opinion to the diagnosis. When compared to the start of treatment now I was a bit confused as to why the paraprotein was fluctuating.

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hi,

Welcome back to icliniq.com.

  • In that case, you should be started on treatment for multiple myeloma.
  • Fluctuations can be there, but treatment needs to be initiated.

For further doubts consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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