Lambda Light Chains

Blood

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No Fasting Required

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Immunoglobulin free light chains.

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Lambda Light Chains Test Information Guide

Why is it done?
- Detects and measures free lambda light chains produced by plasma cells in the blood and urine
- Diagnoses and monitors plasma cell disorders such as multiple myeloma, light chain myeloma, and Waldenström macroglobulinemia
- Evaluates patients with unexplained renal failure or nephrotic syndrome to identify light chain disease
- Assesses clonal disorders and monoclonal gammopathies of uncertain significance (MGUS)
- Monitors treatment response and disease progression in patients with known plasma cell dyscrasias
- Ordered when patients present with bone pain, anemia, hypercalcemia, or recurrent infections suggestive of myeloma
Normal Range
- Serum Free Lambda Light Chains: 0.57-2.63 mg/dL (5.7-26.3 mg/L)
- Urine Free Lambda Light Chains: <100 mg/24 hours or <10 mg/L in spot urine
- Kappa to Lambda Ratio (Serum): 0.26-1.65 (normal ratio indicating balanced production)
- Normal values indicate appropriate immunoglobulin production with balanced kappa and lambda light chain synthesis
- Elevated lambda levels or abnormal kappa/lambda ratio suggests monoclonal gammopathy or plasma cell disorder
- Results are typically measured in mg/dL (serum) or mg/24 hours (urine)
Interpretation
- Elevated Lambda Light Chains: May indicate multiple myeloma (especially lambda light chain myeloma), light chain disease, Waldenström macroglobulinemia, light chain MGUS, or systemic amyloidosis
- Abnormal Kappa/Lambda Ratio: Deviation from normal ratio (either skewed toward lambda or kappa) indicates clonality suggestive of monoclonal gammopathy
- Elevated Urine Lambda Chains: Suggests light chain proteinuria (Bence Jones proteinuria), which may indicate myeloma, light chain disease, or renal involvement
- Discordant Serum and Urine Results: May indicate early kidney disease or selective renal reabsorption; requires clinical correlation
- Serial Changes: Rising levels during treatment suggest disease progression; falling levels indicate good therapeutic response
- Factors Affecting Results: Renal function (affects clearance), hydration status, timing of collection, concurrent infections, hemolysis, and age-related immune changes
- Clinical significance includes risk stratification in myeloma, assessment of light chain burden in kidney disease, and monitoring of treatment efficacy in plasma cell dyscrasias
Associated Organs
- Primary Organ Systems:
- Bone marrow (source of abnormal plasma cells producing excess lambda light chains)
- Kidneys (primary site of light chain filtration and reabsorption; prone to light chain damage and myeloma kidney disease)
- Immune system (dysregulation of immunoglobulin production)
- Associated Medical Conditions:
- Multiple myeloma (particularly light chain myeloma producing predominantly lambda chains)
- Light chain deposition disease (LCDD) with renal involvement and progressive kidney dysfunction
- Light chain cast nephropathy (myeloma kidney) characterized by acute kidney injury and tubular damage
- AL amyloidosis (systemic amyloid formation with cardiac, renal, and nervous system involvement)
- Waldenström macroglobulinemia with monoclonal IgM production
- MGUS (monoclonal gammopathy of uncertain significance) requiring monitoring
- Potential Complications from Abnormal Results:
- Progressive chronic kidney disease and renal failure requiring dialysis
- Systemic amyloidosis affecting multiple organs with poor prognosis
- Bone complications including lytic lesions, hypercalcemia, and pathologic fractures
- Immune dysfunction leading to infections and disease progression
Follow-up Tests
- Recommended Based on Abnormal Results:
- Serum and urine protein electrophoresis to characterize monoclonal protein and confirm light chain disease
- Immunofixation electrophoresis for definitive identification of immunoglobulin type (IgG, IgA, IgM, IgD, IgE)
- Kappa and lambda serum light chain measurement to assess the kappa/lambda ratio and light chain burden
- Bone marrow biopsy with morphology, immunophenotyping, and FISH cytogenetics if myeloma suspected
- Comprehensive metabolic panel including creatinine, BUN, and calcium for renal function and myeloma staging
- Urine light chains quantification (24-hour urine protein electrophoresis and immunofixation)
- Skeletal survey or low-dose whole body CT scan to assess for lytic bone lesions
- Renal biopsy with electron microscopy if light chain kidney disease suspected
- Cardiac imaging (echocardiography) if amyloidosis is suspected
- Monitoring Frequency for Ongoing Conditions:
- MGUS: Every 6-12 months to detect progression to active myeloma
- Active myeloma on treatment: Every 4-12 weeks during active therapy to assess response
- In remission: Every 3-6 months for surveillance and early detection of relapse
- Light chain disease with kidney involvement: Monthly during critical phase; then every 3 months
- Amyloidosis: Every 3-6 months to monitor disease progression and treatment response
- Complementary Tests:
- Free kappa light chains to calculate and interpret the kappa/lambda ratio accurately
- Beta-2 microglobulin for additional prognostic staging in myeloma
- Complete blood count to assess for cytopenias associated with myeloma
- LDH (lactate dehydrogenase) for prognosis and assessment of disease burden
Fasting Required?
- Fasting Status: No, fasting is not required for lambda light chain testing
- Patient Preparation Instructions:
- For serum testing: Routine arm venipuncture with blood collection into appropriate tube(s); no special preparation needed
- For 24-hour urine collection: Patient should collect all urine over 24 hours in provided container; first morning void is discarded, last void included
- For spot urine collection: Random urine sample or early morning first void can be used
- Maintain normal hydration status; avoid excessive dehydration which may concentrate urine and elevate light chain levels
- Medications to Consider:
- No medications need to be held specifically for this test
- Continue all regular medications as prescribed unless specifically instructed otherwise by physician
- Note that certain medications may affect immune function and potentially influence results; inform laboratory of all medications
- Other Preparation Requirements:
- Timing: Blood samples should ideally be collected at consistent times if serial monitoring; morning collection is standard
- For urine collections: Record exact start and end times; refrigerate collection container if not processed immediately
- Avoid strenuous exercise 24 hours before testing as this may temporarily elevate light chain levels
- Ensure proper sample labeling with patient identifiers and collection date/time for test accuracy

How our test process works!