Multiple myeloma laboratory tests

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

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 cases have high levels of IgG
• 20% of cases have high levels of IgA
• 5–10% of cases have 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

• 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.

References

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