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This question was answered on Wed 28, Jul 2010 07:07pm by Dr Dennis S, MD

High IGM, RBC, Hemoglobin, Hematocrit and low WBC


    
Asked by miya (Female; 38; extreme fatigue, bone pain in leg, ribs, back shoulder blade and joints, weight loss, poor appetite, hair loss, weakness, mental confusion, impaired memory, seizure history, impaired immune response, Mono at 15 and relapsing/chronic EBV ) on Tue 27, Jul 2010 03:19pm
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A recent blood test showed high protein levels (8.4), so my doctor ordered a PE and IFE, CBC among other tests to follow-up. The results of those tests showed: WBC: 3.6 (low), RBC: 5.54 (high), Hemoglobin: 17.1 (high), Hematocrit: 49.9 (high), and IGM 242 (high) with 'Kappa and lambda typing appearing increased.' The PE scan is pending. Sed rate is 1. Can you help me to interpret these findings? Prior to this, I had an appointment with The Cleveland Clinic in Ohio set for August 12 with their rheumatology/immunology dept. and am wondering also if I am heading to the right department as I continue with the testing/diagnostic. Thank you.

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Answer by Dr Dennis S, MD  on Wed 28, Jul 2010 07:07pm:

Hi Miya. Do you also have the differential count of your cbc? Your white blood cell count is lower than normal, which could mean that there is an ongoing infection. An empiric antibiotic therapy can be instituted after appropriate cultures are done. Other causes of decrease in white blood cell count include intake of certain drugs like penicillins and steroids. Autoimmune disorders and hematologic disorders are also causes. Aside from consulting a rheumatologist, you may also want to consult a hematologist and/or an infectious disease specialist for further evaluation. Regards.

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Follow up:

Clarification by miya on Thu 29, Jul 2010 05:42pm:
Yes, it appears to be a CBC w/differential.  Would you like some of those numbers? I am taking no other drugs
(incidentally, am allergic to penicillins).   Doctor said he wanted to do the PE/IFE to identify the reason
for the elevated protein and check for indication of Multiple Myeloma.  The results state there was no M-spike
observed. However, Immunoglobulin M came back high, as I said.  Immunofixation result showed an apparent
Polyclonal Gammopathy; IGM - Kappa lambda typing appear increased. No fever or unusual symptoms since last
batch of tests run a couple of months ago, however, the blood counts have changed from the normal results from
a couple months ago.  I am experiencing pain and feeling of fullness that has been waking me up at night since
this batch of tests done last week. Perhaps spleen?  He also ordered an MRI for an apparent complex partial
seizure he believes I had in his office (thought it was blood sugar, but came back normal when he tested it
there) which I haven't had performed as of yet. -- Hepatitis B/C antigens, Thyroid Peroxidase,
Thyroglobulin antibodies, Lyme, and ANA all came back negative.  Rheumatoid factor, C-reactive tests done
prior to this (recently) were negative.  Complete metabolic panel, T-Cell activation, CD-8 subsets, T + B
Lymphocyte diff., Helper T- Lymph CD-4 and Kappa Lambda free light chains were also tested.  Any further
insights with this information?  I assume they cross-evaluate their findings with other specialists outside
the rheumatology dept., but will request a hematologist and/or infectious disease specialist, if I find that
they do not.  Thank you.
Clarification by miya on Thu 29, Jul 2010 05:47pm:
Sorry, I didn't specify where the pain was:  just below my left ribs, left/mid side of abdomen, hence
'spleen'.  Thanks.

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