Hematology focuses on diseases of the blood, bone marrow, and lymphatic system. Learn about the diagnosis and treatment of anemia, leukemia, and lymphoma.
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Diagnosing Multiple Myeloma requires a comprehensive investigative approach. Because the disease affects the blood, bones, and kidneys, no single test is sufficient. The diagnostic process at Liv Hospital involves a combination of blood and urine analysis, bone marrow examination, and advanced imaging. This multi faceted evaluation is essential not only to confirm the diagnosis but also to stage the disease accurately, which dictates the intensity of the treatment plan. We utilize the International Myeloma Working Group (IMWG) criteria to ensure diagnostic precision.
The hallmark of myeloma is the presence of the monoclonal protein.
This test separates the proteins in the blood based on their electrical charge. In myeloma, a distinct “M spike” is seen on the graph, representing the abundance of the monoclonal antibody.
This test is more sensitive than SPEP. It identifies the exact type of abnormal antibody (e.g., IgG kappa, IgA lambda).
This test measures the amount of “light chains” (kappa and lambda) in the blood. In myeloma, the ratio between these two types is often highly abnormal. This is crucial for monitoring patients who have “light chain only” myeloma which might not show a large M spike.
Patients are often asked to collect their urine for 24 hours. This test detects Bence Jones proteins (light chains) that have been filtered by the kidneys.
Routine blood panels provide evidence of the “CRAB” criteria.
This checks for anemia (low red cells), thrombocytopenia (low platelets), and leukopenia (low white cells) caused by marrow overcrowding.
This measures calcium levels to detect hypercalcemia, and creatinine/BUN levels to assess kidney function. Albumin and Beta 2 microglobulin levels are also checked for staging purposes.
To confirm the diagnosis, doctors must look directly at the factory where the cells are made.
A needle is inserted into the pelvic bone (iliac crest). Liquid marrow is aspirated (suctioned) out, and a small core of solid bone tissue is removed.
The pathologist counts the number of plasma cells. A diagnosis of active myeloma typically requires more than 10 percent clonal plasma cells in the marrow (or a biopsy proven plasmacytoma).
Fluorescence In Situ Hybridization (FISH) is performed on the marrow cells. This looks for specific genetic mutations (translocations or deletions) inside the DNA of the myeloma cells. Identifying high risk markers (like del 17p) helps doctors choose more aggressive therapies.
Visualizing Bone Damage
Modern imaging has moved beyond simple X rays to more sensitive modalities.
This is now the preferred standard for screening bone lesions. It provides a detailed 3D view of the skeleton and can detect smaller holes in the bone that X rays might miss.
MRI is the gold standard for looking at the spine and bone marrow. It can detect focal lesions (clumps of cancer cells) even before the bone is destroyed. It is particularly useful for assessing spinal cord compression.
Positron Emission Tomography uses a radioactive sugar that is absorbed by active cancer cells. This lights up the entire body, showing exactly where the active myeloma is located, including in soft tissues outside the bone (extramedullary disease).
According to IMWG guidelines, active myeloma is diagnosed if there is >10% clonal plasma cells in the marrow AND one or more myeloma defining events.
Note: Patients with these biomarkers are treated as active myeloma even if they don’t have symptoms yet (“SLiM CRAB” criteria).
Staging helps predict how aggressive the cancer is and the likely outcome.
This relies on two simple blood tests: Beta 2 microglobulin and Albumin.
This updated system adds genetic markers (LDH levels and FISH results) to the original ISS. It is more accurate because it accounts for the biological aggressiveness of the tumor.
Not all M proteins mean myeloma.
Doctors must distinguish active myeloma from MGUS (benign) and Smoldering Myeloma (asymptomatic). The key difference is the absence of organ damage (CRAB criteria) in the latter two.
Sometimes the abnormal proteins fold into sticky sheets called amyloid, which deposit in organs like the heart and nerves. This is a related but distinct condition (AL Amyloidosis) that requires specific testing (e.g., fat pad biopsy).
This is a single tumor of plasma cells in one bone or soft tissue area, with no evidence of spread elsewhere in the body.
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It is a peak seen on a protein electrophoresis test that represents the large amount of abnormal antibody produced by the myeloma cells.
It is performed under local anesthesia and sometimes sedation. While there is pressure and a brief sharp sensation, it is generally well tolerated and quick.
Some myeloma proteins (light chains) are very small and pass quickly into the urine, so a 24 hour collection is the only way to measure the total amount accurately.
A skeletal survey is a series of X rays of all the bones in the body. However, modern low dose CT scans are often used now because they are more sensitive.
It means the myeloma cells have specific DNA changes (like deletion 17p) that make them grow faster and potentially resist standard treatments, requiring a stronger therapy plan.
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