I have a kappa/lambda ratio of 2.49, kappa lt chain is 18.7, lambda lt chain is 7.5. spep looks normal. esr is 21. crp is 3. i am jak2 positive. should i be concerned?

Looks normal: I would consult your doctor of course, but the kappa/lambs ratio is only slightly elevated, and being JAK2 positive is not necessarily a diagnosis of increased risk of thrombosis - suggest you get regular check ups every 6-12 months and discuss your lab test results with an internal med doc whose advice you feel comfortable with

High ratio: Are you having any symptoms? I agree with previous MD's advice for followup labs periodically. The concern is whether the elevated kappa/lambda light chain ratio is a marker for early myeloma kappa light chain disease and amyloidosis. In view of this I recommend consulting a hematologist/oncologist for evaluation, advice & follow-up.