The following conditions should be investigated with regard to multiple myeloma:
- Bone pain, anemia, and high SR
- Renal failure or hypercalcemia
Examinations performed when multiple myeloma is a possible diagnosis:
- Blood tests: Hb, white blood cell differential count,thrombocytes, albumin, ionized and total calcium, creatinine, urea, ß-2 microglobulin, proBNP, troponin T, ALP, INR, IgG, IgA, IgM, free light chains (kappa/lambda ratio).
- Serum protein electrophoresis. (Urine electrophoresis is only necessary if there is no detection of pathological FLC ratio or monoclonal component by serum protein electrophoresis, or if the patient will participate in studies).
- Bone marrow examinations: Aspirate smear and FISH. Biopsy.
- Low-dose CT scan of skeleton. This means low-dose CT from knees to vertex.
Excluding other conditions with monoclonal immunoglobulin in serum, with or without increased number of plasma cells in bone marrow and AL amyloidosis, is sometimes difficult. The condition sometimes requires observation and repeated examinations for a final diagnosis. It is also important to remember that most organ manifestations may have other causes and association with the plasma cell clone must be probable.