Should I have my blood work redone or additional blood tests if my anion gap is low?

[dkpleis]

I have hypothroidism and take Synthroid daily. Recent blood work done in Dec. 2015, shows that my anion gap is low (3) - normal range is (5-15 mmol/L) My protein serum is 5.9 within the normal range of 5.6 - 7.9 g/dl and albumin is 3.7 with a range of 3.5 - 4.9 g/dl. These tests did show that I have iron deficiency anemia, and the CBC panel had lots of highs and lows. When I looked back over blood results that I had done a year ago, my anion gap was 7 and I now noticed my Vitamin D level was insufficient (22 ng/ml). Other than the iron deficiency, my doctor hasn't addressed any of these other results. Last years blood tests were done at my request because I had concerns about re-ocurring sinus infections, and I had mentioned to the the doctor that my grandmother, her son and her brother all died of multiple myeloma.  The IgA test done last year was in the normal range (271 mg/dl)  Should I have additional blood work and if so what tests should be done?

[Red_Star]

Thanks caregiver222. :)

[caregiver222]

Excellent presentation, Redstar,

[Red_Star]

"The anion gap is sometimes reduced in multiple myeloma, where there is an increase in plasma IgG (paraproteinaemia).[15]"

- Anion Gap Wikipedia.

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"The immunoglobulin class normally present in the largest amounts in blood is IgG, followed by IgA and IgM. IgD and IgE are present in very small amounts in the blood. IgG accounts for about 60% to 70% of all multiple myeloma cases, and IgA accounts for about 20% of cases."

- Multiple Myeloma Research Foundation - Types of Immunoglobulins In Multiple Myeloma

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"Initial tests for myeloma

If symptoms or the results of routine investigations suggest that a patient may have myeloma, then the following investigations should be performed:[6]

* FBC; ESR or plasma viscosity.
* U&Es and creatinine.
* Calcium, albumin, uric acid.
* Serum protein electrophoresis: shows the type of paraprotein.
* Urine protein electrophoresis: looks for the presence of Bence Jones' protein.
* Quantitative immunoglobulin levels (eg, IgG, IgA, IgM levels): non-myelomatous immunoglobulin can be suppressed. The level of the myeloma paraprotein can also be used to assess response to treatment.
* Plain X-ray of symptomatic areas.

Diagnostic tests for myeloma[1]
Further tests are then needed to confirm the diagnosis:

* Bone marrow aspirate and trephine biopsy, with plasma cell phenotyping.
* Immunofixation of serum and urine to confirm and show the subtype of the paraprotein.
* A skeletal survey.

Tests to estimate tumour burden and prognosis (to be performed by a haematologist):

* Fluorescence in situ hybridisation analysis of bone marrow aspirate.
* Serum beta-2 microglobulin concentration.
* Serum albumin concentration.
* Quantification of monoclonal proteins in serum and urine."

- Patient - Myeloma