Blood is an essential fluid that performs many functions, such as transporting oxygen and providing nutrients to cells. Continuously made in the body, this red liquid consists of several components: plasma, platelets, red blood cells, and white blood cells. Various blood disorders can affect this life-giving system, including anemia, sickle cell disease, and leukemia. Rarely, a person will develop an abnormal protein in the blood—this condition is monoclonal gammopathy.
Monoclonal gammopathy (MGUS) is a rare condition that produces an abnormal protein—an M-protein—in the blood. Different subtypes include IgA-MGUS, IgM-MGUS, IgE-MGUS, IgG-MGUS, and IgD-MGUS. While it usually causes no problems, in some cases monoclonal gammopathy can lead to various cancers such as lymphoma or multiple myeloma over time. For this reason, most cases require close monitoring or regular checkups.
Monoclonal gammopathy is a rare condition that more commonly affects certain demographics. For instance, individuals of African descent have a higher chance of developing the disease, as do men over the age of 70. Those who have a family history of the condition are also more susceptible.
Individuals with low-risk monoclonal gammopathy have a reduced risk of developing cancerous conditions. More specifically, they have a two percent chance of their condition progressing to multiple myeloma or a related disorder within the next 20 years. These individuals tend to have an IgG type M-protein in the blood, an M-protein level of less than 15g/L, and a normal free light chain ratio.
Individuals with high-risk monoclonal gammopathy typically have an M-protein level of more than 15 g/L, IgM or IgA type M-protein in the blood, and an abnormal free light chain ratio. If all three features are present, there is a 58% chance of these individuals developing multiple myeloma or related disorder within the next 20 years; the presence of only one or two of the three features lowers the risk exponentially.
Monoclonal gammopathy typically does not cause noticeable symptoms. Rarely, it can lead to nerve problems such as tingling and numbness, or a rash. Given that monoclonal gammopathy is often asymptomatic, individuals may not realize they have the condition. More often than not, the disorder is detected by coincidence during a blood test for another reason.
Monoclonal gammopathy occurs when abnormal plasma cells produce M-protein, a type of immunoglobulin. Generally speaking, this only becomes a problem when too much accumulates in the body, as it crowds out healthy cells. The exact cause for this accumulation is not known, but environmental triggers and genetic changes seem to play a role.
Doctors often detect monoclonal gammopathy during blood tests for another condition. Upon noticing the extra compound, the doctor will likely administer further tests to determine the exact amount of M-protein in the blood. To rule out other causes, doctors may suggest additional blood tests, imaging tests such as MRI or CT scans, urine tests, x-rays of the bones, or quantitative immunoglobulin tests. In some cases, they may perform a bone marrow biopsy—a procedure in which a small needle extracts a small amount of tissue for analysis. Such a procedure, however, is typically reserved for those who are at a higher risk of developing serious disease.
Monoclonal gammopathy itself does not require treatment. Given that it is a precancerous condition, however, close monitoring of the disease will be necessary in addition to regular checkups. At the clinic, the doctor will monitor various symptoms including pain, unintentional weight loss, weakness, blood abnormalities, heart problems, kidney problems, changes in vision, and bleeding. If there are signs of disease progression, treatment will begin as soon as possible.
Each year, an individual’s risk of developing a more serious condition increases by one percent. In other words, someone who has lived with monoclonal gammopathy for ten years has a ten percent risk of disease progression. In addition to multiple myeloma—one of the more common complications—monoclonal gammopathy can lead to Waldenstrom macroglobulinemia, lymphoma, light chain amyloidosis, or Bence Jones proteinuria. Other complications include blood clots, kidney problems, and bone fractures.
No one can control whether or not this disease will progress to something serious. However, individuals can control several aspects of their health. For instance, it is important to attend regular checkups; the earlier a doctor can detect a serious condition, the better the treatment outcome. In addition, it helps to get adequate sleep, eat a healthy diet—one that consists of a variety of fruits and vegetables—and reduce stress.
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