Globulin Testing

[KyleeR]

Hey team 👋🏼

Can anyone share any information or experiences on Globulin Testing? My levels seem to be rising steadily, is this a normal by product of ET or something else?

Thank you

[hunter5582]

There is no real way to answer your question without a lot more information, including whether globulin levels are still within reference range. It could be anything from normal variation to a reaction to medications or something else entirely.

Globulins are a group of proteins in your blood. They are made in your liver by your immune system. Globulins play an important role in liver function, blood clotting, and fighting infection

High globulin levels may be a sign of:

Infection

Inflammatory disease

Immune disorders

Certain cancers, such as multiple myeloma, Hodgkin lymphoma (also called Hodgkin disease), or malignant lymphoma.

Abnormal results may also be caused by certain medicines, dehydration, or other conditions. To learn what your results mean, talk with your provider.

medlineplus.gov/lab-tests/g...

This is a concern that is best addressed by your care team/MPN Specialist. Please let us know how you get on and what you learn. All can benefit from your experience and knowledge.

[KyleeR in reply to hunter5582]

Thanks Hunter for your reply. For a few reasons I have just had my usual bloods once a month. December - normal blood test time, but I also had covid, this showed a few out of range. January - follow up from December and then February - back to my normal test cycle.

During this time they have crept from 34 g/L ; 35 g/L ; 36 g/L - now H as the range is 25-35, and then further back 32 g/L back in August 2022.

All about bloods results have come back normal - apart from the obvious high platelets which are sitting stable at around 540s

Of course I get these results the day after my catch up with the Haematologist. Have sent her an email to follow up.

[hunter5582 in reply to KyleeR]

Following up with the hematologist is the best thing to do. This may well be just a tempest in a teapot. My globulin tends to run on the low side of the reference range. i have been one point low on the reference range a few times. It is no big deal and it always returns to normal the next time. We just watch and carry on.

All the best. Do please let us know how you get on.

[KyleeR in reply to hunter5582]

Thank you. It really is a learning curve trying not to freak out every time there’s an anomaly on my tests 🫣

[merlisa in reply to hunter5582]

Hello Hunter,

From the perspective of interpretation, you are a relatively understanding person, and you may be a doctor. I can see from the changes of total liver protein in the past few years of illness that my total liver protein and prealbumin go down little by little, very slowly, even too slow to discover. This is what I found after collecting all the examination data after my illness.

In fact, I have found that my spleen was getting bigger every year since 2013. Due to the lack of good doctor's guidance, the blood also was not very high. I ignored blood diseases and always looked at the liver department. At that time, only the spleen was enlarged, and the liver morphology and some enzyme indexes were normal. In the next few years, not only the spleen was still growing, but also the nodules began to appear on the liver. Many small nodules. It may make my liver look like a pockmarked face i think. At that time, many doctors worried that I was suffering from liver cancer, but luckily, those nodules were benign, and they have grown safely on my liver until now. But I only know that they are benign, I don't know what they are. It may need minimally invasive surgery and tumor section to determine. Then I was diagnosed as MPN by the department of hematology. Because MPN has always had problems with blood coagulation, that is why I have not chosen to undergo minimally invasive surgery. After all, they are safe.

But here comes the problem. This problem is the liver protein I just mentioned. My liver protein has been declining slowly. I know that the inflammatory factors of MPN will affect or consume prealbumin. This may be one of the reasons that affect the decline of total liver protein, but many patients with MPN who have been ill for a long time around me have no problem of liver protein decline at all, although their prealbumin will be slightly lower than the normal value. Only I have low liver protein. For this reason, I checked whether I have various indicators of hepatitis A, hepatitis B, hepatitis C and other viral hepatitis, and also checked the indicators of rheumatism immunity, and even many indicators such as alpha fetoprotein. Thay are in normal. Now I can only doubt whether it is caused by my liver tumor. I want to see liver surgery. In short, I have lost. What is wrong with me? What should I do?

(At present, my liver function is only low in liver protein, and enzymes are normal. In addition, I have jaundice and hemolysis, so my bilirubin is high.)

I hope you can give me guidance in any direction. Thanks!

[hunter5582 in reply to merlisa]

I am not a doctor, just a guy with PV and a few other interesting health learning opportunities. I have chosen to become more educated about the issues that impact me so that I can do a better job collaborating with my care team and make good decisions about my health.

I would not presume to make a guess at exactly what is going on with your liver and other issues. I would note that the body is a complex interactive system. When we have co-occurring conditions they can and do affect each other. That is why it is so important to create a collaborative treatment team that includes the correct specialists. It is necessary for the patient to be the case manager of their own treatment team, participating as part of the collaboration. It helps when the specialists work within the same system, but can be done when they do not.

I also have a lesion on my liver, spleen and lung. I also have had a brain tumor that was resected. This is all in the context of also having a MPN for 30 years. I also have Neurofibromatosis Type 1. I have learned not to take things for granted. If there is an anomaly, I work with my care team to figure out what it is.

Regarding the liver specifically, the lesion is a likely hemangioma. The same with the spleen. My AST/ALPT/ALP have recently been elevated, which we know is due to the Besremi. Those numbers have returned to normal at this point. The hematology part of my care team is not concerned about liver function but we are keeping an eye on it due to the possible impact of Besremi. I will be reviewing the issue with my gastroenterologist as well.

Given what you have described, I would suggest doing what is necessary to assess what is going on with your liver. I would consider doing whatever diagnostic testing is necessary. A few key questions I would ask are:

1. Are there additional external (noninvasive) scans that would help?

2. What is the least invasive way to do a liver biopsy? is a needle biopsy an option? Note that I suspect you will need a biopsy at some point to answer the question.

3. What role do the medications I have been taking play in how my labs present?

4. What role does the MPN play in my liver function?

The final thing is to ensure that you have a MPN Specialist on your care team. Your case is complex enough that a regular hematologist may not have the base of knowledge about MPNs that you need. You might want to consider a second opinion regardless. Here is a list just in case you need it. mpnforum.com/list-hem./

Please do let us know how you get on and what you learn.

[merlisa in reply to hunter5582]

Hello Hunter5582, Thankd for your positive suggestions!

I have arranged a surgical follow-up these days. The surgeon does not recommend me to perform minimally invasive surgery. As for what the tumor on the liver is, it is suspected that it is a kind of benign hemangioma. It is suggested that the results can be obtained through puncture.

As for the liver protein that I have been worried about, it is suggested that the department of digestive medicine or the department of liver disease should be treated conservatively. Although I have done a series of tests in the department of liver disease, and the results are good. However, I personally think that MPN is a consumptive disease. Due to the effect of COVID-19 and inhibitors, I feel that my immunity is not as good as that of normal people already. If I have some infection or inflammation again, it will consume my liver protein faster. I am now using traditional Chinese medicine therapy to help me improve liver protein. I don't know how effective it is. But if I can come up when I have no clue, I think my thinking is correct, just because it is consumed.

Recently, I found a literature on liver protein and immunity in a place, which may explain why the albumin of MPN is lower than that of normal people, and my total liver protein is lower and lower.

nejm.org/doi/full/10.1056/N...

Hope it could help you!

[Wyebird]

I’ve looked at past blood tests and I’ve never had mine done unless it can be called something else

[hunter5582 in reply to Wyebird]

You can find globulin and other liver function tests on your CMP.

[Wildwood6]

Hi

There is not enough information about your immunoglobulins to give a meaningful reply. Also, you do not mention whether your Covid was treated with any antivirals.

However, I thought I would add a note which might be relevant to you and others. I have immune deficiency as well as MF. My immunoglobulin count has been gradually going down for some years, particularly IgG, which is the possibly most important for immune defence against infections. I had Covid last November and was prescribed Paxlovid (antiviral combination) - very speedily delivered on the NHS - and I noticed that for the first time in a long time, my IgG score went up several notches in a blood test which followed about 2 weeks after the Paxlovid. This is merely anecdotal and I have not seen any reported science on whether Paxlovid can temporarily send up the IgG count, but I thought it worthwhile mentioning.

[merlisa in reply to Wildwood6]

Hello Wildwood6, Liver proteins include hepatic albumin and hepatic globulin. Ig G is one of globulins. Indeed, low protein can lead to immune retardation. Usually, MPN patients should strengthen their own protection to avoid inflammation.