Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:17

Myeloma and Gammopathies 1033

MYELOMA AND GAMMOPATHIES

KENNETH C. ANDERSON, MD

history & physical

■Less than two fold increased risk in farmers, paper producers, furni-

ture manufacturers, and wood workers

■Bone pain or pathologic fracture; recurrent infections; symptomatic

anemia, renal insufficiency, hypercalcemia, or hyperviscosity; nerve

root or spinal cord compression

tests

Basic Blood Studies:

■anemia, leukopenia, thrombocytopenia, renal insufficiency,

hypercalcemia, quantitative monoclonal protein with associated

hypogammaglobulinemia

Basic Urine Studies:

■Quantitative monoclonal protein and albumin

Basic Bone Studies:

■Lytic lesions and/or osteoporosis on bone survey

Specific Diagnostic Tests

■Excess plasma cells on bone marrow biopsy

■Excess plasma cells on tissue biopsy of plasmacytoma

Other Tests as Appropriate

■serum ß2 microglobulin

■C reactive protein

■Lactic dehydrogenase

■Serum viscosity

■Nuclear magnetic resonance imaging of spine (suspected cord com-

pression or solitary plasmacytoma of bone)

■Computerized tomographic scan (plasmacytoma)

■Cytogenetics

■Plasma cell labelling index

■Bone marrow flow cytometry

differential diagnosis

■Monoclonal gammopathy of unknown significance: low level mon-

oclonal protein in blood and/or urine without other symptoms or

signs of myeloma