Multiple myeloma laboratory tests

Jump to navigation Jump to search

Multiple myeloma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Multiple Myeloma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiograph and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Multiple myeloma laboratory tests On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Multiple myeloma laboratory tests

All Images
X-rays
Echo and Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Multiple myeloma laboratory tests

CDC on Multiple myeloma laboratory tests

Multiple myeloma laboratory tests in the news

Blogs on Multiple myeloma laboratory tests

Directions to Hospitals Treating Multiple myeloma

Risk calculators and risk factors for Multiple myeloma laboratory tests

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [3] Shyam Patel [4]

Overview

Laboratory findings consistent with the diagnosis of multiple myeloma include abnormal complete blood count, abnormal basic metabolic panel, elevated monoclonal protein on serum electrophoresis, elevated serum free light chains, and presence of myeloma-specific protein markers by immunohistochemistry or immunophenotyping. Some of the laboratory tests are factors that determine the stage of multiple myeloma.

Evaluation of multiple myeloma

Evaluation of multiple myeloma
Evaluation of multiple myeloma[1]

Laboratory Findings

Complete blood count[2][3]

Peripheral blood smear

  • Rouleaux formation of red blood cells[2][3]: This is defined as the stacking of 4 or more red blood cells. In healthy individuals, the zeta potential of red blood cells causes intercellular repulsion. However, in patients with multiple myeloma, there are many positively charged paraproteins, which antagonizes the negative charge on red blood cells and allows for stacking.

Basic metabolic panel[2][3]

  • Hypercalcemia due to increased osteoclasts activity: This is one of the defining features of end-organ damage in multiple myeloma.
  • Increased serum creatinine level due to reduced renal function: This is one of the defining features of end-organ damage in multiple myeloma.
  • Abnormal blood urea nitrogen
  • High alkaline phosphatase level
  • High serum protein level with normal/decreased albumin level: This creates a high protein gap, which is defined as the difference between the albumin level and the total protein level.
  • High lactate dehydrogenase: This occurs in stage III multiple myeloma as defined by the Revised-International Staging System (R-ISS).

Serum protein electrophoresis[2][3]

  • 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

Urine studies

  • Presence of monoclonal paraprotein on urine protein electrophoresis
  • Elevated 24-hour urine protein
  • Elevated urine free light chains

Free light chain immunoassay

  • Elevated free kappa light chain
  • Elevated free lambda light chain
  • Elevated free light chain ratio
  • Potentially offers an improvement in monitoring disease progression and response to treatment[2][3]

Immunofixation

  • Identifies the type of M-protein or immunoglobulin light chain detected by serum or urine electrophoresis[2][3]

Quantitative immunoglobulin assay[2][3]

  • 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: β2-microglobulin level is one factor that determines the stage of multiple myeloma.

Immunophenotyping

References

  1. "Multiple Myeloma: Diagnosis and Treatment - - American Family Physician".
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Multiple myeloma. Wikipedia(2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September 2015


Template:WikiDoc Sources