Lambda Light Chains free

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Immunoglobulin free light chains.

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Lambda Light Chains Free - Comprehensive Medical Test Guide

Why is it done?
- Detects and measures free lambda light chains produced by plasma cells in the blood and urine, which are immunoglobulin components normally produced in small quantities
- Diagnose and monitor multiple myeloma, a cancer of plasma cells that produces excessive monoclonal light chains
- Detect light chain disease (Bence Jones proteinuria), where free light chains accumulate in the kidneys causing damage
- Evaluate monoclonal gammopathy of undetermined significance (MGUS) and light chain MGUS
- Monitor progression and treatment response in patients with plasma cell dyscrasias
- Assess kidney function in patients at risk for light chain-induced renal damage (myeloma kidney, cast nephropathy)
- Identify light chain escape during multiple myeloma treatment, where patients relapse with light chain production but normal immunoglobulin levels
- Screen for AL amyloidosis, where misfolded light chains deposit in tissues causing organ dysfunction
Normal Range
- Serum Free Lambda Light Chains: 0.57 - 2.63 mg/dL (milligrams per deciliter) or 5.7 - 26.3 mg/L
- Kappa/Lambda Ratio: 0.26 - 1.65 (when considering both kappa and lambda together); normal kidneys should filter out excess free light chains, resulting in minimal urinary excretion
- Urine Free Lambda Light Chains: < 2.42 mg/24 hours (24-hour urine collection)
- Reference ranges may vary between laboratories; always check specific lab reference values
- Normal Result: Free lambda light chains within reference range indicate normal plasma cell function with no clonal light chain production
- Abnormal Result: Elevated free lambda light chains (above 2.63 mg/dL) suggest clonal plasma cell proliferation, monoclonal gammopathy, or impaired renal clearance
- Borderline Values: Levels slightly above normal (2.63 - 5.0 mg/dL) warrant repeat testing and clinical correlation, as they may indicate early clonal disease or laboratory variation
Interpretation
- Moderately Elevated (2.63 - 10 mg/dL): May indicate MGUS (monoclonal gammopathy of undetermined significance), light chain MGUS, or early myeloma; requires follow-up testing and bone marrow evaluation
- Markedly Elevated (> 10 mg/dL): Consistent with multiple myeloma, light chain myeloma, or AL amyloidosis; clinically significant and requires immediate further investigation
- Severely Elevated (> 100 mg/dL): Highly indicative of advanced multiple myeloma or light chain disease with significant risk of kidney damage and systemic complications
- Abnormal Kappa/Lambda Ratio: Deviation from normal ratio (< 0.26 or > 1.65) indicates clonal light chain production; lambda-only elevation suggests monoclonal disease with lambda light chain production
- Elevated Urine Levels: Presence of free lambda light chains in urine (> 2.42 mg/24 hours) indicates proteinuria and possible light chain-induced kidney damage; higher levels correlate with increased renal dysfunction risk
- Serum-to-Urine Ratio: Elevated ratio (> 50:1) may indicate renal impairment affecting normal light chain clearance; important marker for myeloma kidney development
- Factors Affecting Results: Renal function (impaired kidney clearance increases levels); dehydration (concentrates levels); recent chemotherapy (may lower levels); laboratory-specific assays (different methods may yield slightly different reference ranges); polyclonal light chain increase in benign conditions like infection or inflammation
- Clinical Significance: Superior to serum and urine protein electrophoresis for detecting early myeloma and light chain disease; serves as prognostic marker with higher levels associated with worse prognosis; used to define myeloma in revised CRAB/SLiM criteria; helps detect minimal residual disease and treatment response
Associated Organs
- Bone Marrow: Primary site of plasma cell proliferation; abnormal expansion produces excessive monoclonal light chains in multiple myeloma and related disorders
- Kidneys: Primary target organ for light chain toxicity; accumulation leads to myeloma kidney (cast nephropathy), light chain-induced acute kidney injury, and chronic kidney disease; responsible for filtering and reabsorbing light chains
- Heart: Affected in AL amyloidosis where misfolded lambda light chains deposit as amyloid fibrils, causing restrictive cardiomyopathy and conduction abnormalities
- Nervous System: Amyloid deposits can cause peripheral neuropathy, autonomic dysfunction, and carpal tunnel syndrome in AL amyloidosis patients with lambda light chain involvement
- Liver and Spleen: May accumulate amyloid deposits in AL amyloidosis, causing hepatomegaly and splenic dysfunction
- Multiple Myeloma: Malignancy causing bone destruction, hypercalcemia, renal damage, and anemia; lambda-secreting myeloma accounts for approximately 50% of cases
- AL Amyloidosis: Systemic disease with potential multi-organ involvement; predominantly lambda (67%) or kappa (33%) light chains form amyloid fibrils; affects heart, kidneys, nervous system, and other organs
- Light Chain MGUS: Benign monoclonal proliferation; may progress to myeloma or AL amyloidosis over time; requires monitoring
- Waldenström Macroglobulinemia: Lymphoplasmacytic lymphoma producing monoclonal IgM; can produce excess light chains affecting similar organ systems
Follow-up Tests
- Serum and Urine Protein Electrophoresis (SPEP/UPEP): Identifies monoclonal spike and characterizes type of immunoglobulin and light chain produced; confirms presence of M-protein
- Serum Free Kappa Light Chains: Measured simultaneously with lambda to determine kappa/lambda ratio; critical for diagnosis of monoclonal gammopathy
- Bone Marrow Biopsy and Aspiration: Necessary for definitive multiple myeloma diagnosis; assesses plasma cell percentage, cytology, and genetic abnormalities
- Complete Blood Count (CBC): Evaluates hemoglobin, hematocrit, platelets, and white blood cells; myeloma often causes anemia and cytopenias
- Comprehensive Metabolic Panel: Assesses kidney function (creatinine, BUN), calcium levels, and electrolytes; critical in light chain disease monitoring
- 24-Hour Urine Protein and Creatinine: Quantifies proteinuria; high levels indicate significant light chain urinary excretion and renal damage risk
- Immunofixation Electrophoresis (IFE): Identifies specific immunoglobulin and light chain type; more sensitive than standard electrophoresis for detecting monoclonal proteins
- FISH and Cytogenetics: Detects chromosomal abnormalities (del13, t(4;14), t(14;16), del17p) with prognostic significance in myeloma
- Kidney Biopsy with Light and Electron Microscopy: May be needed to confirm light chain-induced kidney disease and assess degree of tubular damage
- Bone Survey or PET/CT Scan: Evaluates for osteolytic lesions and bone involvement in multiple myeloma
- Cardiac Assessment (Echocardiography, Cardiac Biomarkers): Screen for amyloid-related cardiomyopathy in AL amyloidosis patients
- Repeat Testing: Monthly or quarterly monitoring in confirmed myeloma to assess treatment response; annually in MGUS to monitor for progression
Fasting Required?
- No: Fasting is not required for serum free lambda light chain testing; blood can be drawn at any time of day
- Patient Preparation: No special fasting requirements; patients may eat and drink normally before blood draw
- Hydration: Adequate hydration before blood draw is recommended; dehydration can falsely elevate light chain levels
- Medications: No need to avoid any medications; continue all regular medications as prescribed unless otherwise instructed by physician
- 24-Hour Urine Collection: If urine free lambda light chains are being measured, proper 24-hour urine collection is required; collection should be refrigerated and started in morning after voiding
- Special Instructions: For 24-hour urine collection, discard first morning void, then collect all urine for next 24 hours including final morning void the next day; use provided container and preservative if supplied
- Timing: Blood samples should ideally be consistent timing if serial monitoring is being performed for treatment response assessment

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