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] Shyam Patel [3]

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.[1][2][3]

Laboratory Findings

Complete blood count[1][2]

Peripheral blood smear

  • Rouleaux formation of red blood cells[1][2]: 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[1][2]

  • 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[1][2]

  • 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[1][2]

Immunofixation

  • Identifies the type of M-protein or immunoglobulin light chain detected by serum or urine electrophoresis[1][2]

Quantitative immunoglobulin assay[1][2]

  • 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. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 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
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Multiple myeloma. Wikipedia(2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September 2015
  3. Rajkumar SV, Kumar S (January 2016). "Multiple Myeloma: Diagnosis and Treatment". Mayo Clin. Proc. 91 (1): 101–19. doi:10.1016/j.mayocp.2015.11.007. PMC 5223450. PMID 26763514.


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