Protein

MULTIPLE MYELOMA(MM) objective: definition of MM Biochemical investigation in Diagnosis and prognosis Basil O M Saleh


MULTIPLE MYELOMA (MM)• A neoplastic (malignant) proliferation of asingle clone (group) of plasma cells in bone marrow• Major laboratory diagnostic criteria• >10% plasma cells in bone marrow• Complete or incomplete monoclonalimmunoglobulin(s) in serum and/or urine atelevated concentrations• Monoclonal Immunoglobulins (Antibodies) • Monoclonal proteins, M proteins or paraproteins • Non-functional

Paraprotein appears as a sharp peak (a "spike"),most often in the gamma region, though it may beanywhere. Such a peak indicates the presence of a monoclonal gammopathyA majority of detected monoclonal gammopathies arethe result of plasma cell myeloma. These patientstypically have depression of other gamma globulinsand albumin.Some other causes of monoclonal gammopathiesinclude: Waldenstrom's macroglobulinemiaheavy chain diseaseCLL, lymphoma, amyloidosis (occasional cases.


RADIOLOGY DIAGNOSIS OFMULTIPLE MYELOMA•Skeletal bone X-ray series•Skull, spine, ribs, arms, legs and pelvis•Alternative procedures•Magnetic resonance imaging (MRI)•Computed tomography (CT)•Computerized axial tomography (CAT)• Lytic bone lesions and/or pathologic fractures


Laboratory analysis1. significant increased ESR (erythroctesedimentation rate) > 90 mm3/hr.2.Serum protein electrophoresis SPE (M band)3.Bence Jones protein BJP in urine (positiveband); 85 % of cases and it is the most important test in diagnosis of MM4. Hypercalcaemia & hyperphosphataemia5. hyper uremia & hypercreatininemia6. Hyperuricemia7. Hypoalbuminemia8. Normal ALP9. decreased Hemoglobin (Hb)

The results of these investigations depend onthe stage of MM, for example; increasedurea, creatinine, uric acid anddecreased s. albumin occur whenkidney integrity and function declinebecause of precipitation of BJP in it and the consequent kidney damage.