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Elevated IgG
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Elevated IgG

Does anyone know what would cause an elevated IgG? I was diagnosed with MS in April. At the time the dr told me that the LP was negative. He just said that I had an elevated protein that had nothing to do with MS. I just gound out today what was elevated.

I am waiting for an appt with a rheumy because PCP thinks I may have lupus and MS. So I was just wondering if anyone knows if this could be lupus related.

Thank you
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how elevated is elevated?  Your IGG is a mmeausre of your immune system in a way.  If you are fighting a virus (flu/ colds etc) it can be elevated as your immune system fights it.  If your IGG stays elevated (this was your IGG in your blood?) you need to furthur investigate it.  There is a tes called and electropherisis that can investigate the type of protein. What are your other blood counts like? (white cells, red cells, etc)

This is what led to my diagnosis (not MS!) I see a hematologist/ medical oncologist, not a rhemetologist (sorry about the spelling)

once I got really sick I had a lot of not MS symptoms that the MS specialist was shrugging off including a weird lacy skin rash, swollen optic disks, and other wierd things.
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What was your diagnosis?

The increased IgG was in my spinal fluid.

Currently my HCT, HGB, MCHC and RBC are low. And my MPV is a little high. So the PCP says anemia but not sure what kind because she did not check ferretin to see if it is low iron. But I did have a neagtive ANA last month.
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i have something called multiple  myeloma, which is a rare cancer of the bone marrow that causes malignant overproduction ofc ertain white cells which are plasma cells.  My type is IGG, so I my IGG protein is excessive, when I was diagnosed it was very high 5 or 6 times normal.  When I was finally on the right track to figuring it out Lupus was one of the things they were testing for.  My hemoglobin when I was finally diagnosed was 80 (or 8.0 depending how your lab reports it) because I had so many plasma cells.
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The elevated IgG in your CSF is part of the things they measure to determine something called an IgG Index.  If that (the index) is high then it is considered a positive finding that points toward MS.  So, I disagree that the elevated IgG has nothing to do with the consideration of MS unless I see the whole enchilada.  Do you have a value for the Ig/g Index?

As far as the anemia:  What is the value of the RDW (Reticulocyte Distribution Width)?  If this number is 16 or higher it is indicative of an iron deficiency anemia.  

The RBC, HMG, HCT, MCHC and the MPV don't reveal much in the way of what may be causing the anemia - it's just "anemia".

If the MCH, the MCH, are high they indicate anemia from something like B12 or folate deficiency.  If they are low they are more suggestive of iron deficiency anemia or anemia of chronic disease (as can be seen in Lupus).  If they are normal, they could indicate anemia of chronic disease.

MPV changes  must be interpreted along with other things.  It might indicate a bledding or clotting problem, but that is a wild guess.

I'm most concerned with the IgG in your CSF - did the report give a value for the Index?

Quix
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Thank you so much for your reply. I am just really going thru alot with my health right now with getting the MS diagnosis in april and now the yare looking at possibly lupus as well. So I am trying to learn as much as possible for going to the rhuemy.

I unfortunatly do not know anything else about the IgG but I will be going by their office tomorrow to get a copy so I will let you know.

My RDW is 14.5 so it was normal.
MCH was 28.4
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Hopefully you can help me understand this now. I just picked up the report of my LP and everything was normal but 3 things. Here they are:

IgG (Ioc)   2.73H     reference <0.10
IgG Index   1.80H     "    < 0.70
CNS IgG Synthesis Rate 13.5H  reference <3.3

Can you tell me what this means? And thank you for your help
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147426_tn?1317269232
Your IgG Index is mildly elevated.  This is a positive result with regard to looking for MS according to the McDonald criteria.  That is why they run it.  Your neuro is off-base.  Most neuros, though are less impressed with the IgG index than with O-Bands.  But, still, it shows that the antibodies are being produced in the CSF at a higher rate than in the body.  That is important information.

I'm going to do some research to see if the IgG Index has been discredited or why neuros won't pay attention to it.  It definitely shows immune-inflammation occurring at a higher rate than the rest of the body.  But, you almost never see a reference to it in the literature.

Quix

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So sorry, I mis typed. The reference range for the IgG index is actually  <0.70
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147426_tn?1317269232
I just did a quick review of articles discussing the IgG Index from the last couple years.  The Index is still considered a valid test.  There are a small number of other diseases that will also cause an elevation of the IgG Index so it is a little less specific than O-Bands.  The literature quotes the number of people with MS that will have an elevated Ig Index is close to 90%

Now, Mandy, NONE of the 10 sources I looked at have the particular range that your result shows.   I believe that the lab printing this result has a mistake in it's programmed range.  A person has to enter the expected range and typos do happen and are often missed.  I experienced this more than once in my practice.

The national range always has an upper limit of right around 0.7 for the normal value.  NO WHERE did I find a lab with the upper range of 1.7 as in your lab.

So this means that your value of 1.8 is MARKEDLY elevated and is a pointer toward MS as your diagnosis.  The other possibilities for an elevated IgG Index that I saw were Neurosyphillis, CIPD, and Subacute Sclerosing Panencephalitis (SSPE).  All of these can be distinguished from MS with testing.

So, recheck you lab result to see if the range you wrote is correct.  If it is, someone needs to contact the lab director and have this range investigated.  

Your neuro is either terribly uneducated about MS or was fibbing to you.  The issue needs to be raised with him by someone, maybe your PCP.

Here is the search I used on Google.  Remember to look for references that are recent.

Multiple Sclerosis CSF IgG Index

Yes, it has EVERYTHING to do with MS - He needs enlightening.

Quix
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Thank you. I actually typed it wrong. Could the IgG have anything to do with lupus?
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147426_tn?1317269232
No, this has to do with immuno-inflammation that is occurring soley in the central nervous system.  Lupus occurs throughout the entire body - it is systemic.

Part of my diagnosis was based on my IgG Index which was a little lower than yours.

I wonder on what planet the neuro got his info?

Q

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I'm not sure but I am upset that I did not get this info sooner. He never would send it to my PCP either. I guess he just saw no O bands and that was all he cared about.
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147426_tn?1317269232
WE can find a bunch of medical sources for you to print out to show that the IgG Index has use, even if it isn't as strong as O-Bands.  The good diagnosing doctor will not dismiss ANY useable information.  He probably is one of those weenies that believes that 100% of people with MS have O-Bands.  Sheeesh!

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Thank you again for all the info. Get this, I was looking a little harder at the results and the dr had circled :no bands" but I noticed that is the reference range. For my results it actually says:

"the patients CSF contains <5 well defined gamma restriction bands that are not present in the patients corresponding serum sample. These bands indicate abnormal sythesis of gammaglobulins in the CNS. This finding is supportive evidence of MS"

I can't believe what an idiot this neuro is.
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