II. Types: Plasma Cell Peripheral Disorder

III. Screening: Indications

  1. Normocytic Anemia
  2. Non-age appropriate bone loss
  3. Proteinuria
  4. Peripheral Neuropathy
  5. Increased total protein

IV. Evaluation

  1. Establish Monoclonal Protein (M Protein) is present
    1. Obtain Serum Protein Electrophoresis (SPEP)
    2. Urine Protein electrophoresis (UPEP)
  2. Characterize the M Protein with immunofixation
    1. Clonal Bone Marrow plasma cell percentage 60% or higher in Multiple Myeloma
  3. Evaluate CRAB Criteria (end-organ injury consistent with Multiple Myeloma)
    1. Calcium
      1. Hypercalcemia (Serum Calcium >11 mg/dl)
    2. Renal Insufficiency
      1. Serum Creatinine >2 mg/dl (GFR <40 ml/min)
    3. Anemia
      1. Hemoglobin < 10
    4. Bony Lesions
      1. One or more osteolytic lesions on XRay, CT or PET CT
  4. Evaluate plasma free light chains
    1. Free Light Chain Ratio (FLC Ratio, involved to uninvolved ratio 100 of higher)

V. References

  1. Thompson (2017) Monoclonal Gammopathy, Mayo Clinical Reviews, Rochester, MN

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