II. Types: Plasma Cell Peripheral Disorder
- Common
- Uncommon
- Waldenstrom Macroglobulinemia
- Amyloidosis
- B-Cell Non-Hodgkin Lymphoma
- Rare
- Plasmacytoma
- Plasma Cell Leukemia
III. Screening: Indications
- Normocytic Anemia
- Non-age appropriate bone loss
- Proteinuria
- Peripheral Neuropathy
- Increased total Protein
IV. Evaluation
- Establish Monoclonal Protein (M Protein) is present
- Obtain Serum Protein Electrophoresis (SPEP)
- Urine Protein electrophoresis (UPEP)
- Characterize the M Protein with immunofixation
- Clonal Bone Marrow plasma cell percentage 60% or higher in Multiple Myeloma
- Evaluate CRAB Criteria (end-organ injury consistent with Multiple Myeloma)
- Calcium
- Hypercalcemia (Serum Calcium >11 mg/dl)
- Renal Insufficiency
- Serum Creatinine >2 mg/dl (GFR <40 ml/min)
- Anemia
- Hemoglobin < 10
- Bony Lesions
- One or more osteolytic lesions on XRay, CT or PET CT
- Calcium
- Evaluate plasma free light chains
- Free Light Chain Ratio (FLC Ratio, involved to uninvolved ratio 100 of higher)
V. References
- Thompson (2017) Monoclonal Gammopathy, Mayo Clinical Reviews, Rochester, MN