Diagnosis

History

The patients age and gender should be noted. Myeloma is more common in the elderly and is not seen in children; it is also slightly more common in men.
Symptoms are related to progression of myeloma, which leads to bone resorption, bone marrow failure and increased production of immunoglobulins.

  • Bone resoprtion leads to bony pain or pathological fractures. Hypercalcaemia can cause dehydration, confusion, stones or abdominal pains.
  • Bone marrow failure causes pancytopenia. The most common clinical symptoms are related to anaemia (present in 80% of patients) and associated fatigue. More advanced cases may present with excessive bleeding due to thromobocytopenia.
  • Patients may present with renal failure due to immunoglobulin chain deposition in the glomeruli of the kidney.

The duration and severity of symptoms should be noted. Particularly painful bony sites may respond to radiotherapy more rapidly than systemic treatments and it is important to identify the presence of these symptoms.

Past History

A previous history of monoclonal gammopathy of undetermined significance is present in a minority of patients.

Medications/Allergies

Standard questions only

Family History

Relatives of a patient with myeloma have a four-fold increase in the risk of developing myeloma.

Social History

There is a suggestion in some patients that chronic occupational exposures to radiation or toxic chemical compounds may lead to the development of myeloma. Most patients have no apparent cause.


Examination

Signs are related to the same pathological features of myeloma:

  • Patients may be tender over involved bones (particularly the spine)
  • Signs of anaemia (pallor, pale palmar creases, pale conjunctiva)

Investigations

The final diagnosis of myeloma relies on:

  • Demonstration of at least 10% replacement of bone marrow by a clonal plasma cell component
  • Demonstration of a raised monoclonal immunoglobulin in the blood or urine

Staging


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