Tag: Ferritin

Serum Protein Electrophoresis (SPEP) Test

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I have been looking at results from these since December 2021 when the wife had her Myeloma diagnosis. There was a large monoclonal peak in the gamma globulin area, a characteristic “finger print”. I have seen dozens of these electrophoresis traces. Her therapy quickly reduced the monoclonal peak below the detection thresholds. The technique is key to the diagnosis of Myeloma and smouldering Myeloma.

My blood is having one of these tests done today. I have found that Canadian healthcare web sites have a nice balance of detail and not treating you as a numpty.

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South Tees Hospital Pathology

“Serum electrophoresis is essential in the investigation of suspected paraproteinaemia and immune deficiency. Characteristic patterns are also seen in the presence of an acute phase response, nephrotic syndrome, alpha 1 antitrypsin deficiency, inflammatory and infective disorders. SPE is performed on all specimens submitted for immunoglobulin quantitation to check whether the immunoglobulins are polyclonal or monoclonal proteins. Polyclonal increases are due to and increased activity of numerous different lymphocytes and are associated with a wide range of infectious and inflammatory diseases including liver disease. The main value in serum electrophoresis is detection of monoclonal immunoglobulins associated with lymphoid malignancy, myeloma or related haematological disorders. Since quantitative immunoglobulin measurements cannot differentiate between monoclonal and polyclonal immunoglobulins, paraprotein determination (monoclonal protein) must be carried out by quantitation of bands obtained on electrophoresis.”

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From https://myhealth.alberta.ca

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“The serum protein electrophoresis (SPEP) test measures specific proteins in the blood to help identify some diseases. Proteins are substances made up of smaller building blocks called amino acids. Proteins carry a positive or a negative electrical charge, and they move in fluid when placed in an electrical field. Serum protein electrophoresis uses an electrical field to separate the proteins in the blood serum into groups of similar size, shape, and charge.

Blood serum contains two major protein groups: albumin and globulin. Both albumin and globulin carry substances through the bloodstream. Using protein electrophoresis, these two groups can be separated into five smaller groups (fractions):

  • Albumin. Albumin proteins keep the blood from leaking out of blood vessels. Albumin also helps carry some medicines and other substances through the blood and is important for tissue growth and healing. More than half of the protein in blood serum is albumin.
  • Alpha-1 globulin. High-density lipoprotein (HDL), the “good” type of cholesterol, is included in this fraction.
  • Alpha-2 globulin. A protein called haptoglobin, which binds with hemoglobin, is included in the alpha-2 globulin fraction.
  • Beta globulin. Beta globulin proteins help carry substances, such as iron, through the bloodstream and help fight infection.
  • Gamma globulin. These proteins are also called antibodies. They help prevent and fight infection. Gamma globulins bind to foreign substances, such as bacteria or viruses, causing them to be destroyed by the immune system.

Each of these five protein groups moves at a different rate in an electrical field and together form a specific pattern. This pattern helps identify some diseases.

Serum protein electrophoresis is most often done to help diagnose and monitor a wide variety of conditions. These include:

  • Some forms of cancer.
  • Problems with the kidneys or liver.
  • Problems with the immune system.
  • Conditions that lead to poor nutrition.

High values

High values may be caused by many conditions. Some of the most common are shown here.

  • High albumin: Dehydration
  • High alpha-1 globulin: Infection; inflammation
  • High alpha-2 globulin: Inflammation; kidney disease
  • High beta globulin: Very high cholesterol; low iron (iron-deficiency anemia)
  • High gamma globulin: Inflammation; infection; liver disease; some forms of cancer

Low values

Low values may be caused by many conditions. Some of the most common are shown here.

  • Low albumin: Poor nutrition; inflammation; liver disease; kidney disease
  • Low alpha-1 globulin: Some genetic problems
  • Low alpha-2 globulin: Kidney disease; some cancers
  • Low beta globulin: Poor nutrition
  • Low gamma globulin: Problems with the immune system “

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Given the high levels of ferritin yet normal levels of transferrin in my blood, the primary screen has to be for liver disease. But the bullet point for cancer above has quite a list behind it. I guess that the beta globulins may be abnormal in some way because of Iron. Anything weird in the gamma region means more tests…There are rheumatological factors. The tests show inflammation. I don’t think at 100kg I class a malnourished.

Anything non-standard will mean more tests [probably].

I’ll speculate that more tests are somehow “on the cards”.

Genetic Counsellors and Cans of Worms

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I learned a new phrase today “genetic counsellor”. Apparently, at least in Canada, such things exist. I have been recommended to have the HFE gene test to see if I have hereditary haemochromatosis (HH). This for completion. Back in 1994 I visited this high haemoglobin “space” and was bled regularly at St Thomas’. Retrospect suggests that I may have had an ongoing health condition which was missed back then.

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They took an armful each time. 

This HFE mutation would provide a benign explanation for my raised haem and ferritin levels. My ferritin levels have been increasing with time over the last four years. I don’t really have many of the symptoms associated with the genetic disease. It is linked with the less benign polycythaemia. Which would require a wider more substantive gene panel test, so-called molecular oncology. The authorisation for this testing is probably reserved for specialists. Iron overload is not without consequences. It can “cause” cancer or be correlated with it. Medical literature often blurs correlation with cause.

The problem with all this new-fangled gene testing is that it can open a can of worms

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Needless to say, the genetics are complex.

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I would be a mutant of sorts…

The next stages are Iron MRI and/or liver biopsy. The latter does not sound like much fun!!

Liver disease is possible maybe even likely, but I am largely asymptomatic. My enzyme work was ok.

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The next stage of inquiry would be to look for myeloproliferative neoplasms which are rare, not lottery winning rare, but rare enough. Search of JAK 2 and other related things starts increasing the price. JAK 2 can mutate.

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“Mutations in JAK2 have been implicated in polycythemia vera, essential thrombocythemia, and myelofibrosis as well as other myeloproliferative disorders. This mutation (V617F), a change of valine to phenylalanine at the 617 position, appears to render hematopoietic cells more sensitive to growth factors such as erythropoietin and thrombopoietin, because the receptors for these growth factors require JAK2 for signal transduction. JAK2 mutation, when demonstrable, is one of the methods of diagnosing polycythemia vera.”

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The thing is looking closely at most people my age the chances are that you will find something which has gone wrong.

The French sites suggest that some kind of follow up is warranted because of my Iron status.

Not sure what if anything the GP will recommend….

The osteoporosis situation seems simpler to treat with some pills, supplements and vitamins. But could have an Iron cause.

Given that the haemoglobin situation has been ongoing for, perhaps, thirty years it seems unlikely that any new unpleasant things have suddenly taken hold. But the ferritin level has doubled since 2021.

There is part of me that thinks that I just let this all drop…The osteoporosis might have enabled the fracture of my femoral neck six years ago. I have perhaps been living with it since. Simple answer is to not fall over.

A few more pills is no big deal however…

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hereditary haemochromatosis – regularly being bled.

Not HH – Iron MRI / Liver biopsy —

Liver disease – it depends on what – treatments in absence of virus are usually diet and no booze.

Something fancy and esoteric – myeloproliferative neoplasms – massive complex can of worms

The French sites suggest that some kind of follow up is warranted because of my Iron status.

What is inside the can…?

White Coats – DNA – Gene Testing – Lab Instrument Dream – 03 -06 -2025

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Here is last night’s dream.

It opens in an ethereal very white laboratory setting in which there are no walls. There are people milling about in white laboratory coats. Most of these are young. Some have pencils and pens in the coat pocket. There is a prevalence of spectacles. I am sat at a large white desk upon which are computer terminals linked into the DNA sequencer machines. I am with two younger women both wearing white lab coats, neither of which are done up. They have name-identity-security cards on deep blue lanyards around their necks. One is blond the other dark haired. They are younger than me and “official”. I am dressed in civvies, black jeans and a black cashmere jumper. My hair has a fresh buzz-cut.

The dark haired woman asks me how the genetic testing was authorised. I explain that my haemoglobin levels are high and that I have a large excess of ferritin in my blood. She nods and gestures for me to open the files on the computer in front of me. These files contain my full DNA results and parts where the study has zoomed into specific genes of concern regarding my blood and health. Before we get to the results there is a screen showing who has accessed these files. There is a list of health professionals in normal black type. Then in a box ringed in bright red and backlit is one saying D. Someone who I once was acquainted with. The files access log says that he has accessed these files illegally and without proper authorisation on a number of occasions. He has been illegally monitoring my test results. The woman asks me if I know who it is. Yes. Somehow, he has contrived illegal access. He has been snooping on my genetic testing and passing them on. It is illegal, he has been unlawful.

The scene changes to an ultramodern biochemistry laboratory on an upper floor. There are wet benches, fume hoods and instrumentation suites. Everybody apart from me is decked out in white lab coats. They are all younger than me and exude and air of quite professionalism going about their business. I enter a glass doored laboratory instrumentation suite. At the “welcome” desk there is a young man and a young woman. He asks how he might help. I explain that I need to run a sample. He shows me into to their latest machine. It is a hybrid mass spectrometer-NMR- separation machine. They are convinced that I know little to nothing about science instruments and mass spectrometry in particular. I say that before I run my sample, I need to assess the signal to noise ratio of the instrument. I inspect it.

When I am ready, I inject my sample using a micro-litre syringe into the septum at the spectrometer inlet. The results will be available in a few hours. Everyone thinks that I am a pleb, who knows nothing. The next day I return and ask to run the sample again. I have left it on the bench to oxidise overnight and that will give me an added insight into the chemical composition. The man is a bit reluctant but lets me run the sample again.

The dream ends.

High Haemoglobin High Ferritin Normal TSAT – More tests?

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Following on from the visit to the rheumatologist I have had my ferritin and transferrin saturation levels tested again today. This rules out hereditary hemochromatosis so no need for HFE genetic testing.

It does not rule out liver disease though my liver enzyme tests were good a month ago. It can be due to chronic inflammation, which I have. It can be due to alcohol misuse but the level has gone up and I am completely on the wagon for four months now. She suggested JAK poly gene screening for myeloproliferative neoplasms (MPNs) to help explain the polycythaemia and to definitively rule out these rare malignancies. The GP said that this was very specialised testing and would need a haematologist to authorise. We will see the wife’s haematologist next week.

As is so often the case one test instead of closing options / diagnoses, opens others. My upcoming sleep apnoea study might add another clue to the mix.

In 1994 I was bled on a regular basis at St Thomas’ hospital to try to address the high haemoglobin levels. They took several “armfuls” … But memory says this increased the haemoglobin levels a few weeks after they pulled the pint.

Maybe I should buy some leeches and have a DIY approach.

I have just found out that I also have mild osteoporosis in the hips which is fairly normal aged related and lower bone density in my spine, osteopenia, slightly more advanced than normal for my age.

Must get a hamster wheel or a challenge reward maze from Amazon…

More questions…

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Ready For the Knacker’s Yard

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“A knacker, knackerman or knacker man is a person who removes and clears animal carcasses (dead, dying, injured) from private farms or public highways and renders the collected carcasses into by-products such as fats, tallow (yellow grease), glue, gelatin, bone meal, bone char, sal ammoniac, soap, bleach and animal feed. A knacker’s yard or a knackery is different from a slaughterhouse or abattoir, where animals are slaughtered for human consumption. Since the Middle Ages, the occupation of “knacker man” was frequently considered a disreputable occupation. Knackers were often also commissioned by the courts as public executioners.

Etymology

The oldest recorded use of the word “knacker” dates to 1812, meaning “one who slaughters old or sick horses” and in 1855 “to kill, castrate”, and is believed to be the same word as the earlier knacker/nacker “harness-maker” from the 1570s, surviving in 18th century dialects. The sense extension is perhaps because “knackers” provided farmers with general help in horse matters, including the disposal of dead horses and animals. The word is of uncertain origin, perhaps from the Scandinavian word represented by Old Norse hnakkur, saddle, and related to hnakki, “back of the neck”, possibly relating to neck.”

Excerpted from Wikipedia

The medical merry-go-round continues…

“Prostate-specific antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), P-30 antigen, is a glycoprotein enzyme encoded in humans by the KLK3 gene. PSA is a member of the kallikrein-related peptidase family and is secreted by the epithelial cells of the prostate gland in men and the paraurethral glands in women.

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As part of my three monthly MOT or Controle Technique, I had some blood tests yesterday. My Ferritin is elevated as is my PSA. The PSA result is above normal again and on an upward trend. I have had a digital {finger} and MRI scan and my prostate gland is enlarged. Last year there were no observable lesions in the MRI images.

The odds on prostate cancer have changed. It is more likely.

We were told to get back in touch with the piss-takers {urology} if my PSA result had gone up. The wife has been trying to get through. If ever there was a nanna-disease it is water works.

I have measured my blood pressure and at 133/85 it seems to be one of the few things still working. I am due a dental implant end of May and now have toothache to boot. Any infection will prohibit the implant.

I have just been preparing a detailed chronology / image database for a rheumatology private consultation “thanks” to my new printer. I needed to scan some documents. HP Smart is a misnomer. There is no way adding a “smart” “modern” printer to a WiFi network needs to be so fucking difficult.

Bring back serial ports and 9600 dot matrix baud rates…all is forgiven.

The so called “appli” or application which I downloaded onto a “smart” phone as a last resort did not work either…the Windows version failed to accept the correct network key!! To be told over and again that the correct network key is incorrect is not good. I have made a consumer choice never to buy HP again.

I once had a Kodak printer and it was the best. Simple. Easy to use. Effective. Cheap to run.

The number of things currently wrong and going wrong is increasing. Maybe the time to reincarnate as soap or glue is fast approaching….