Hematology Question 27 Instructor

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”).


  • 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.

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