You are referred a patient with normocytic anemia (Hgb 88g/L), calcium of 2.93mmol/L, and creatinine of 140mmol/L. She is speculated to have multiple myeloma.
What investigations are prudent for diagnosis? What complications are associated with myeloma?
Definition of Multiple Myeloma: Any M protein or bone marrow plasmacytosis with evidence of end organ dysfunction from clonal plasma cell growth (also known as “CRAB”).
“CRAB”:
- hyperCalcemia
- Renal failure
- Anemia
- Bony disease
Complications include from myeloma include:
- Bony pain from osteolytic lesions and compression fractures.
- Systemic features such as fatigue due to the anemia and accumulating tumour burden.
- Hematological complications:
- Cytopenias.
- Bone marrow failure.
- Bleeding.
- Hyperviscosity.
- Renal failure.
- Hypercalcemia.
- Increased incidence of infections.
- Neurological complications:
- Spinal cord and nerve root compression.
- Peripheral neuropathy.
- Intracranial plasmacytomas.
Investigations for myeloma: Skeletal survey, bone marrow biopsy (with specimens sent for cytogenetics), 24 hour urine collection for UPEP, and proteinuria.
Blood work must include a full CBC, calcium profile, Serum protein electrophoresis with immunofixation, beta2 microglobulin level and free light chain analysis.
