Multiple myeloma laboratory tests: Difference between revisions

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Revision as of 16:57, 21 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory findings consistent with the diagnosis of multiple myeloma include abnormal complete blood count, erythrocyte sedimentation rate (ESR), basic metabolic panel, electrophoresis and immunohistochemistry. An elevated concentration of serum protein level without concomitant elevation of serum albumin level is very suggestive of multiple myeloma.

Laboratory Findings

Complete blood count

Anemia
Thrombocytopenia
Elevated erythrocyte sedimentation rate

Peripheral blood smear

Rouleaux formation of red blood cells.

Basic metabolic panel

Hypercalcemia due to increased osteoclasts activity
Raised serum creatinine level due to reduced renal function
Abnormal blood urea nitrogen
High alkaline phosphatase level
High serum protein level with normal/decreased albumin level

Urinalysis

A 24-hour collection of urine is usually needed to examine the amount of protein

Electrophoresis

Protein electrophoresis is a method that separates proteins in the serum or urine
70% of people with multiple myeloma have high levels of IgG
20% of people with multiple myeloma have high levels of IgA
5–10% of people with multiple myeloma produce only immunoglobulin light chains (Bence Jones proteins)
Rarely κ- or λ-light chains may be secreted in isolation.

Free light chain immunoassay

Potentially offers an improvement in monitoring disease progression and response to treatment.

Immunofixation

Specialized type of electrophoresis that identifies the type of M-protein or immunoglobulin light chain detected by serum or urine electrophoresis.

Quantitative immunoglobulins assay

Quantitative measurement of IgA, IgG, IgM immunoglobulins to detect immune paresis
Monoclonal gammopathy (IgA and/or IgG peak)
Reverse albumin:globulin ratio (low albumin, high globulin)
Elevated β2-microglobulin level

Immunohistochemistry

Multiple myeolma cells are typically CD56, CD38, CD138 positive and CD19 and CD45 negative.

Cytogenetics may also be performed in myeloma for prognostic purposes.

References

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@@ Line 12: / Line 12: @@
 * Elevated [[erythrocyte sedimentation rate]]
-====Quantitative immunoglobulins assay====
+====Peripheral blood smear====
-* Quantitative measurement of IgA, IgG, IgM immunoglobulins to detect immune paresis
+*Rouleaux formation of red blood cells.
-* Monoclonal gammopathy (IgA and/or IgG peak)
-* Reverse albumin:globulin ratio (low albumin, high globulin).
-* Elevated β2-microglobulin level
 ====Basic metabolic panel====
@@ Line 24: / Line 21: @@
 * High alkaline phosphatase level
 * High serum [[protein]] level with normal/decreased albumin level
+====Urinalysis====
+*A 24-hour collection of urine is usually needed to examine the amount of protein
 ====Electrophoresis====
-* Quantitative  measurements of the paraprotein are necessary to establish a diagnosis and to monitor the disease.
+*Protein electrophoresis is a method that separates proteins in the serum or urine
-* [[Protein electrophoresis]] of the blood and urine might show the presence of a [[paraprotein]] (monoclonal protein, or M protein) band, with or without reduction of the other types of immunoglobulins (known as immune paresis).
+*70% of people with multiple myeloma have high levels of IgG
-* One type of paraprotein is the [[Bence Jones protein]] which is a urinary paraprotein composed of free light chains.
+*20% of people with multiple myeloma have high levels of IgA
+*5–10% of people with multiple myeloma produce only immunoglobulin light chains (Bence Jones proteins)
+*Rarely κ- or λ-light chains may be secreted in isolation.
+====Free light chain immunoassay====
+*Potentially offers an improvement in monitoring disease progression and response to treatment.
+====Immunofixation====
+*Specialized type of electrophoresis that identifies the type of M-protein or immunoglobulin light chain detected by serum or urine electrophoresis.
-* The paraprotein is an abnormal [[immunoglobulin]] produced by the tumor clone.
+====Quantitative immunoglobulins assay====
-* Very rarely, the myeloma is ''nonsecretory'' (not producing immunoglobulins).
+* Quantitative measurement of IgA, IgG, IgM immunoglobulins to detect immune paresis
-* In theory, multiple myeloma can produce all classes of immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM.  IgD and IgE myeloma are very rare.
+* Monoclonal gammopathy (IgA and/or IgG peak)
-* In addition, light and or heavy chains (the building blocks of antibodies) may be secreted in isolation: κ- or λ-light chains or any of the five types of heavy chains (α-, γ-, δ-, ε- or μ-heavy chains).
+* Reverse albumin:globulin ratio (low albumin, high globulin)
+* Elevated β2-microglobulin level
 ====Immunohistochemistry====
-* Staining particular cell types using antibodies against surface proteins) can detect plasma cells which express immunoglobulin in the cytoplasm but usually not on the surface; myeloma cells are typically [[CD56]], [[CD38]], [[CD138]] positive and [[CD19]] and [[CD45]] negative. [[Cytogenetics]] may also be performed in myeloma for prognostic purposes.
+*Multiple myeolma cells are typically [[CD56]], [[CD38]], [[CD138]] positive and [[CD19]] and [[CD45]] negative.
-* Other useful laboratory tests include quantitative measurement of [[IgA]], [[IgG]], [[IgM]] ([[immunoglobulin]]s) to look for immune paresis, and β2-microglobulin which provides prognostic information.  On peripheral blood smear the rouleaux formation of red blood cells is commonly seen.
-* The recent introduction of a commercial immunoassay for measurement of free light chains potentially offers an improvement in monitoring disease progression and response to treatment, particularly where the paraprotein is difficult to measure accurately by electrophoresis (for example in light chain myeloma, or where the paraprotein level is very low). Initial research also suggests that measurement of free light chains may also be used, in conjunction with other markers, for assessment of the risk of progression from [[monoclonal gammopathy of undetermined significance]] (MGUS) to multiple myeloma.
+ [[Cytogenetics]] may also be performed in myeloma for prognostic purposes.
 ==References==