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I have experienced a change in bowl habits and I have been seen by a gastroenterology who diagnosed me with IBS. My primary recently ran a total bilirubin test and found my direct bilirubin was elevated (direct = 0.3 indirect = 2.0. He wants me to see a hematologist. Is this common?Hello and thank you for reading. I am a 25 year old male, no prior medical history, non smoker, non drinker, very active (run 20 miles a week). I started to have increased bowl movements (5-7 a day on bad days), very lose stools. Its been pretty frustrating. I made an appointment with my GP, he ran standard blood work (CMP/CBC) and the only thing there was elevated bilirubin of 2.0 which he said was just Gilbert's syndrome.. He referred me to gastroenterology.The gastroenterologist ran a C-reactive test, calprotectin stool test, whatever the celiac marker test is, and all were normal. His assessment was that it is IBS and no treatment is needed. I went back to my GP per a followup. He felt it was worth doing an ultrasound of my abdomen and a total bilirubin test. Ultrasound was normal, bilirubin test was 2.0 indirect and 0.3 direct. The normal direct is suppose to be < 0.2.The direct bilirubin test was done on November 4th. I'd seen the results and assumed they were not remarkable. On November 22nd, I get the following e-message from his RMA:"Your recent labs indicate your direct bilirubin is high which could indicate hemolyis. You need to follow up with hematology as soon as possible. Feel free to contact us as soon as possible"I was pretty irked to get this message 20 days after I'd already seen the lab results myself. I also felt like more context would be helpful on what as soon as possible meant... does it mean in the next few days or next few weeks or next few months...Ultimately, all I was wanting to know is if this is common practice for that lab result... could that elevation of direct bilirubin be related to Gilbert's? I appreciate the insight.
gpt
It's probably going to be Gilbert's. But who knows, sometimes it's not.
M-Spike. How concerned should I be?My allergy doctor somehow decided to test me for some antibodies & some other things due to some unusual symptoms and I had an M-Spike result. She was quite concerned.Specifically, the test was "Protein Immunofix Electrophoresis, Serum Details" and the result was "abnormal band identified as monoclonal IgG kappa."I went to my primary care provider who ordered some follow-up tests, which I just got back. The results are in the table below. Most are normal, but the first one is presumably a repeat test (and same result) of the igG kappa.On Wednesday I'm meeting with a Hematology/Medical Oncology doctor. In the meantime I'm wondering if I should be losing sleep over this. Because I am.I'm 50 yrs old, 5' 9", 150 lbs., male, I take pepcid, non-smoker. I've been having some strange symptoms for five years (balance, adult onset scoliosis, right sided fatigue, bone pain on the right side).Thank you.
Note: I am not a hematologistLooks like monoclonal gammopathy of uncertain significance (MGUS). A small percentage of people with this condition will progress each year to a low-grade malignancy called smoldering multiple myeloma or to overt multiple myeloma. Some people may develop other malignancy of the plasma cells (mature B cells that produce memory antibodies). Most people are simply monitored for rising amounts of the monoclonal protein over many years, and don't require treatment.Monoclonal proteins may be associated with elevated Factor VIII, which can predispose patients to blood clots. If you have a history of DVT or pulmonary embolism, the presence of these proteins could be a reason to consider ongoing anticoagulation medication long-term. If you haven't had a blood clot, it may be a reason to consider DVT prophylaxis when in high-risk situations, such as surgery or long periods of travel or prolonged bedrest.Your hematologist will probably tell you to have blood tests periodically to monitor the level of monoclonal protein. Based on the data that you gave, it doesn't look like you have a large amount of abnormal protein, so you are unlikely to require treatment.