Paraprotein
management- The presence of a serum paraprotein band is not diagnostic of myeloma
- Monoclonal gammopathy of unknown significance (MGUS) is a common explanation for low concentration paraprotein bands and requires follow-up
- Urine and serum electrophoresis should be performed for suspected plasma cell dyscrasia
- Paraprotein bands can be associated with other non-myeloma disease, including amyloid lymphoma, leukaemia, infection, and chronic inflammatory disease
- Absence of paraprotein bands does not include plasma and dyscrasia
- Initially 3-6 month electrophoresis for IgG, IgA, or IgM bands of less than 15 g/l in patients without signs or symptoms
- Annual electrophoresis thereafter for stable IgG, IgA, or IgM bands of less than 15 g/l, where there are no accompanying indicators for a plasma cell dyscrasia
- Referral to a haematologist for IgA or IgG bands > 15 g/l or IgG, IgA, or IgM bands < 15 g/l with accompanying indicators for a plasma cell dyscrasia and other Ig bands (IgE and IgD are rare)
- Immediate tests after initial identification of a monoclonal band: full blood count, calcium, and renal function
Serum immunoglobulins should be measured and an electrophoresis performed:
- As part of the primary screen for suspected plasma cell dyscrasias (myeloma, lymphoma, chronic lymphatic leukaemia, heavy chain disease, amyloid)
- As part of the diagnostic investigation of suspected primary and secondary immunodeficiency—that is, patients with recurrent documented infections
They are of secondary value in the investigation of:
- Liver disease
- Connective tissue disease
- Sarcoidosis
- Chronic infection
www.myeloma.org.uk—Information for patients and professionals on myeloma and links to related topics