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Understanding Your MULTIPLE MYELOMA LAB TESTS

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B:8.75” T:8.5” S:8.5” Understanding your MULTIPLE MYELOMA LAB TESTS This booklet explains common tests for patients with multiple myeloma. Your doctor uses them to help diagnose and assess your multiple myeloma, and monitor your progress and side effects. B:11.25” S:11” T:11” Reference ranges in this booklet are adapted from Mayo Clinic Laboratory Test Reference Values. The ranges listed on your report may be different. Contact your healthcare team to address any specific questions you may have related to your laboratory tests. VEL214CDNY6055_F_PatientKit_UnderstandingLabTestsBook_r22.indd 1 7/9/15 10:22 AM B:17.25” T:17” S:17” This worksheet can serve as a personal record to better understand your lab test results. The laboratory performing the test should provide the associated reference range with the test Reference ranges—values that are considered normal in healthy individuals—are provided below results. To learn more about each test, refer to the sections inside the booklet. Your healthcare team as guides. Note that ranges vary among laboratories. will review your tests with you at your next appointment. Mark the test values in the Mark the test values in the column below each date column below each date Date of laboratory test Date of laboratory test Reference ranges Reference ranges COMPLETE BLOOD COUNT (CBC) Pages 4-5 SERUM QUANTITATIVE IMMUNOGLOBULINS (Igs) Pages 9-10 White blood cells (WBCs) 3.5-10.5 × 109/L IgG 767-1590 mg/dL WBCs (neutrophils) 1.7-7.0 × 109/L IgA 61-356 mg/dL Males: 4.32-5.72 × 1012/L Red blood cells (RBCs) IgM 37-286 mg/dL Females: 3.90-5.03 × 1012/L Males: 38.3-50.0% Hematocrit IgD ≤10 mg/dL Females: 34.9-44.5% B:11.25” S:11” Males: 13.5-17.5 g/dL T:11” Hemoglobin (Hgb) IgE Mean=13.2 kU/L Females: 12.0-15.5 g/dL SERUM IMMUNOFIXATION (IFE) Page 11 Platelets 150-450 × 109/L IFE N/A CHEMISTRY PROFILE Pages 6-8 SERUM FREE LIGHT CHAIN ASSAY Pages 11-12 Glucose, serum (fasting) 70-100 mg/dL Kappa free light chain 0.33-1.94 mg/dL Blood urea nitrogen (BUN), serum 7-20 mg/dL Lambda free light chain 0.57-2.63 mg/dL Creatinine, serum 0.6-1.3 mg/dL Kappa/lambda free light chain ratio 0.26-1.65 Protein, total, serum 6.3-7.9 g/dL 24-HOUR URINE ANALYSIS Pages 13-14 Calcium, total, serum 8.9-10.1 mg/dL 24-hour urine total protein <115 mg/12 hours Beta2-microglobulin, serum 1.21-2.7 mcg/mL M spike, urine N/A SERUM PROTEIN ELECTROPHORESIS (SPEP) Pages 8-9 Urine immunofixation N/A Males: 77-160 mL/min/BSA M spike (myeloma gamma globulin) N/A Creatinine clearance Females: 56-131 mL/min/BSA 2 3 VEL214CDNY6055_F_PatientKit_UnderstandingLabTestsBook_r22.indd 2-3 7/9/15 10:22 AM B:17.25” T:17” S:17” Complete blood count (CBC) Red blood cells (RBC) 12 Blood vessel A CBC measures the number of red blood cell Normal range: male: 4.32-5.72 × 10 /L; levels, white blood cells, and the total amount of female: 3.9-5.03 × 1012/L platelets in the blood. Your body produces blood RBCs carry oxygen to body tissues. How much Red blood cells cells in the bone marrow. Since the overgrowth of oxygen your body tissues get depends on how Platelets plasma cells in the bone marrow can crowd out many RBCs you have and how well they work. White blood cells normal cells, leading to low blood counts, blood A low RBC count, or anemia, can make you have cells must be carefully monitored. shortness of breath and feel tired. White blood cells (WBCs) Hemoglobin molecule Hemoglobin (Hgb) Normal range: 3.5-10.5 × 109/L B:11.25” S:11” Normal range: male: 13.5-17.5 g/dL; T:11” WBCs help fight infections. A low WBC count female: 12.0-15.5 g/dL reduces your body’s ability to fight disease. Hemoglobin is a protein in RBCs that carries oxygen in your blood to all parts of your body. Oxygen binds Low hemoglobin levels may show that myeloma to heme on the cells occupy too much of the bone marrow and Red blood cells hemoglobin that not enough space is left for the normal molecule WBC (neutrophils) marrow cells that produce RBCs. Normal range: 1.7-7.0 × 109/L Neutrophils are a type of WBC responsible for much of the body’s protection against infection. Neutrophils are produced in the bone marrow Platelets and released into the bloodstream to travel Normal range: 150-450 × 109/L to wherever they are needed. Since a reduced Platelets are blood cells that help blood to clot. count of neutrophils increases the risk for If your blood has a low number of platelets, you infection, a neutrophil count must be closely Platelets can be at risk for serious bleeding. If your blood monitored throughout treatment. has too many platelets, you may have a higher risk of blood clots. 4 Platelets form clots to stop bleeding 5 VEL214CDNY6055_F_PatientKit_UnderstandingLabTestsBook_r22.indd 4-5 7/9/15 10:22 AM B:17.25” T:17” S:17” A blood sample is taken Chemistry profile Creatinine, serum Kidney A blood chemistry profile can measure the level Normal range: 0.6-1.3 mg/dL of different substances in your blood. Resulting Creatinine is a chemical waste product of creatine. A blood sample is taken levels provide insight to the function of different Creatine is a chemical made by the body and is for a blood chemistry profile organs (kidney, liver, etc) that multiple myeloma used to supply energy mainly to muscles. If kidney and chemotherapy may affect. function is not normal, creatinine level increases in your blood. The evaluation of the BUN and creatinine ratio is an indicator of kidney function. Ureter Bladder Glucose, serum Normal range: 70-100 mg/dL when fasting B:11.25” S:11” Protein, total, serum T:11” Blood sugar, or glucose, is the main sugar found in your blood. Your blood carries glucose to all Normal range: 6.3-7.9 g/dL of your body’s cells to use for energy. The total level of protein in the blood is measured by a total serum protein test. If the test results show abnormal protein levels, then multiple myeloma, kidney, liver, blood, and other autoimmune diseases may be indicated. Glucose in blood Excess glucose A blood sample is taken Blood urea nitrogen (BUN) Calcium Normal range: 7-20 mg/dL Normal range: 8.9-10.1 mg/dL BUN is a measure of the level of urea in your All cells need calcium in order to work. The calcium Kidney blood. Urea nitrogen is what forms when protein blood test measures the level of calcium in the blood. breaks down. BUN levels must be carefully If high levels of blood calcium are revealed, that may monitored in multiple myeloma patients since indicate kidney and bone damage. too much urea nitrogen in their blood puts them at an increased risk for kidney disease. Calcium in blood Low blood calcium Ureter Bladder 6 7 VEL214CDNY6055_F_PatientKit_UnderstandingLabTestsBook_r22.indd 6-7 7/9/15 10:23 AM B:17.25” T:17” S:17” Beta2-microglobulin (B2M) M spike (myeloma gamma globulin) Normal range: 1.21-2.7 mcg/mL Normal A large peak, or M spike, marks large amounts B2M is a protein produced by the malignant of M protein. The amounts of normal Igs may Multiple cells. Although this protein itself doesn’t cause myeloma also decrease. problems, it can be a useful indicator of a patient’s prognosis (outlook). High levels mean the disease is more advanced and may be a Albumin worse prognosis. α1 α2 β γ Serum quantitative immunoglobulins (Igs) Protein electrophoresis Serum protein electrophoresis To measure levels of the major classes of Igs in the blood, this test detects and reveals an B:11.25” S:11” (SPEP) excessive amount of one of the Ig types. Electrophoresis can then determine if this comes from T:11” clones of a cancerous plasma cell. The way your body fights infection is with Serum M spike antibody proteins (Igs), which are produced by proteins normal plasma cells. Myeloma is a cancer of the plasma cells in the bone marrow. In multiple IgG myeloma, the plasma cells produce an abnormal protein called monoclonal protein, or M protein.. Normal range: 767-1590 mg/dL Albumin Globulin SPEP is used to separate and identify the presence IgG antibodies are widespread in the body. Your and levels of M protein in the blood. Each type of body uses IgG antibodies to fight bacterial and viral plasma cell produces only 1 type of Ig. infections. IgA Normal range: 61-356 mg/dL IgA antibodies are mainly present in body secretions and are the chief antibodies in the mucous membranes of the gastrointestinal and respiratory tract, and in saliva and tears. 8 9 VEL214CDNY6055_F_PatientKit_UnderstandingLabTestsBook_r22.indd 8-9 7/9/15 10:23 AM B:17.25” T:17” S:17” IgM 1 1 Serum immunofixation (IFE) 2 2 Normal range: 37-286 mg/dL 3 3 The IFE identifies proteins called Igs in blood. Igs are Your body produces IgM antibodies to help the 4 4 5 5 antibodies that help your body fight infection. If immune system fight infections. IgM antibodies 6 6 the presence of an M protein excess is identified by are found in blood and involved in combating 7 7 the SPEP, the IFE will determine what subtype of M blood infections.
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  • The Effect of Gamma Globulin in Pustular Acne*

    The Effect of Gamma Globulin in Pustular Acne*

    PRELIMINARY AND SHORT REPORT THE EFFECT OF GAMMA GLOBULIN IN PUSTULAR ACNE* LOREN W.SHAFFER,M.D., BENJAMIN SdHWIMMER, M.D. AND RENATO J.STANICCO,M.D. One of us (LWS) bad occasion to treat a young Clinical Response: Patient 1: New lesions ceased white man with gamma globulin for prophylaxisappearing immediately after the first injection. after exposure to infectious hepatitis. He wasBy the third week most of the cystic and pustular given two injections, 10 cc. each, of human Polio-lesions had dried up, and no new ones had ap- myelitis Immune Globulin, one week apart. Itpeared. Comedones were not decreased in number. was observed that shortly after the second injec-The patient maintained his improvement through tion, his severe pustular and indurated acnethe fifth week when the cystic and pustular lesions improved considerably. This observation led tobegan to recur. the present study, of which this is a preliminary Patient 2: New lesions continued to develop report. throughout the period of treatment and the one This study of the therapeutic effect of gammamonth follow up. globulin in pustular acne is coupled with a study Patient 3: There was no observable effect of of the serum protein and C-reactive protein levelstreatment. before and after treatment. Patient 4: The first improvement was seen in Method: Four patients in their late teens, other-the second week and by the third, all cystic and wise healthy, but with severe pustular and cysticpustular lesions were dry. The improvement acne that had been resistant to conventionallasted for two weeks after which the lesions methods of treatment were selected for the study.began to return.