Published on August 6, 2015
Dr. Susan Leclair explains the difference between chemistry and hematology panels and the data each one brings in the diagnosis of myeloma. Hematology is important in diagnosing many conditions. However, chemistry is also a key part in understanding a myeloma diagnosis. The basic metabolic panels test chemistry within the body in the form of albumin and globulin. Chemistry panels look for an increase in globulin, and a serum protein electrophoresis tests examine globulins themselves. The increase in both globulins and calcium should be considered when diagnosing myeloma.She also explains the overall importance of granulocyte and neutrophil levels in detecting abnormalities and stresses there should always be 2,000 counts as they are important cells that defend against infection. Watch now!
Transcript | Diagnosing Myeloma Early Through Chemistry and Hematology Panels
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Okay. Our next question is from Nicoletta. She wants to know what test results are critical to diagnosing multiple myeloma early?
Well, I always like to think hematology is critical for everything, but I have to say this time not so much. The real critical ones are in chemistry, and the number one—and it's a routine test so it happens every time you get a basic metabolic panel—is something called a total protein and an albumin and a globulin.
Multiple myeloma has cells that overproduce a particular type of globulin. So if you see in a total protein that the total protein is increased, albumin is about right where it should be, and the globulin is beginning to increase. Then there's the question of why is the globulin increasing, and the next test that should be done is a serum protein electrophoresis that actually looks at the globulins. It skips albumin, because you're not interested in that. It just looks a globulin fractions.
And sometimes the reason is because you just had an immunization five days ago and so, yeah, everything is activated, because you're making antibodies. Or you're just getting over the flu or some legitimate reason. But if there's no legitimate reason, and you have this increase in globulins, it's worth talking about. This is another place where calcium comes into being, because myeloma is found only in the bone marrow. And there are specific damages that occur to bone cells, and as we all know with osteoporosis the bone cells, when they are damaged, release a lot of calcium. So if the calcium is beginning to sidle its way up and the globulin is beginning to wander its way up, well, then you've got a question of what's going on, and you need additional tests for that.
Judith wants to know is a low white blood cell count significant? Is it anemia? Is it a sign of multiple myeloma?
It is not a sign of anemia. Anemia is a low hemoglobin. White cells really don't—well, they communicate but not well with red cells. A low white cell count is—well, is iffy. You have two populations of white cells in your bloodstream. One of them is circulating around in the bloodstream, flowing freely. The other one is like a bunch of teenagers at an 8th grade dance. All the guys are up against the wall, nobody is going to dance. Well, that's called the marginating cells.
There's a—there's supposed to be a relationship between the two. But if it happens that you have more marginating cells than circulating cells, your white cell count is going to look low, because we only count the circulating cells. So—so that's a possibility.
Another possibility is any time you get damage in the bone marrow—so yes, myeloma would come up in this but so would a lot of other diseases—it might—when you have damage in the bone marrow, when you have some kind of metabolic disorder in them it's like living near a toxic waste dump. The cells begin to have a harder time undergoing mitosis and growing up, so fewer of them get out. So this suppression of the normal cells sometimes happens because of something going bad in the marrow, and so again we get a lowered white count.
Does a lowered white count mean anything specific? Not unless you get—it will either be GR, ABS or GR with a hash tag I guess is what we call it now—I'm trying to stay current. Those kinds of symbols, if that—if the granulocyte or the neutrophil absolute count gets below 2,000, that's important because those are the cells that defend you against infections, and you want to have at least 2,000 of those floating around in order to be able to protect you. So does a 2,300 really cause a physician trouble? Not unless that neutrophil count's below.