Medical examinations and laboratory tests

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If you are reading this, you have probably been in contact with a professional regarding treatment for multiple myeloma. Due to bone issues arising from this disease perhaps you will need traumatology or orthopedic treatment or radiotherapy, whereby painful and damaged bone parts are radiated to alleviate discomforts.

Multiple myeloma diagnosis is confirmed by carrying out numerous laboratory tests, bone marrow tests and diagnostic imaging techniques. Based on the tests carried out, the physician will get a clear picture of multiple myeloma's progression and will be able to decide on the necessary treatment method. Physicians then agree upon the treatment (this is not always necessary) which is best suited to you and inform you about the expected outcomes of the treatment.

Table of certain laboratory values

Lab test Name of test Reference value Unit Commentary
Blood count Leukocyte count 4,0-10,0 x 109/l Due to low leukocyte count you are susceptible to infections
Erythrocyte count (male) 4,5-6,3 x 1012/l Anemia due to low erythrocyte count
Erythrocyte count (female) 4,2-5,4 x 1012/l
Hemoglobin (male) 140-180 g/l Anemia due to low hemoglobin concentration
Hemoglobin (female) 120-160 g/l
Hematocrit (male) 0,40-0,54   Decrease in hematocrites anemia, increase indicates dehydration
Hematocrit (female) 0,37-0,47
Platelets 140-340 x 109/l Due to low platalet count you are more susceptible to bleeding
Biochemistry Urea 2,8-7,5 mmol/l Urea concentration increases due to impaired renal function
Creatinine 44-97 µmol/l Due to imparied function creatinine concentration is elevated
Calcium 2,1-2,6 mmol/l Calcium concentrations often elevated due to bone degradation with patients suffering from multiple myeloma
Albumins 32-55 g/l Patients suffering from multiple myeloma often have decreased albumin concetration
Proteins total 65-80 g/l Patients suffering from multiple myeloma have increased concetration of proteins due to monocioonal immunoglobulin
Monoclonal Immunoglobulin 0 g/l Presence of abnormal proteins with patirnts suffering from multiple myeloma
Kocijančič A., Mrevlje F.,Š tajer D.: Interna medicina. Ljubljana-Littera picta, 2005; Electrophoresis
  • Blood tests
    Blood tests determine erythrocytes, leukocytes, platelets count and the ratio between them.
  • Electrophoresis of protein
    determine concentration of paraprotein
  • Paraprotein

    Protein present in the serum and / or urine of 98% of patients with multiple myeloma; identification and amount in the blood or urine is essential for the diagnosis and evaluation of treatment success. 

    During treatment, patient’s various amounts of all protein is measured in the patient’s blood, M protein (paraprotein, monoclonal protein) in blood and/or urine are regularly monitored as well. The dynamic of multiple myeloma and its response to the treatment is monitored with the protein electrophoresis. If the treatment is effective, the values will reduce.

  • Immunofixation and immunoelectrophoresis
    Data on the subtype of paraprotein, monoclonal protein, can be read out with this additional testing carried out.
  • 24-Hour Urine Protein Test
    Disease progression is monitored by observing concentration of heavy- and light-chain protein depositions in urine. The 24-hour urine protein test enables precise measurements. In the recent years, physicians use this test less and less.
  • Determining immunoglobulin free light-chains in serum

    Determining values of immunoglobulin light-chains in the blood helps when diagnosing and evaluating the dynamics of the disease/response to the treatment.

    Concentration of free light-chains kappa and lambda can be determined in blood especially, but this could be carried out by testing the urine and the fluid found in the space which covers the brain and the spinal cord.

  • Bone marrow test

    The percentage of cancer plasma cells in the bone marrow can be anywhere from 10 to 100 % with patients suffering from multiple myeloma. The growth of plasma cells can be even throughout the area or it can be localized in some areas only.

    Bone marrow test is a key examination for diagnosing multiple myeloma. This examination is critical in determining possible genetic changes in the diseased cells. Chromosomal map or karyotype is made. This enables structural or numerical chromosomal abnormalities to be detected. Physicians will search for some of the most significant chromosomal abnormalities. Chromosomal examination will give your physician important information on the development of the disease. It will show whether or not rapid or gradual progression is to be expected and the treatment can be planned accordingly.

  • Puncture and bone marrow biopsy
    During this examination the physician will make an incision and insert a hollow needle to gain a sample of the fluid of the bone marrow tissue from the rear part of your pelvic bone. 5 – 10 ml of bone marrow or tissue will suffice. The procedure is done at the clinic and does not require the patient to be on an empty stomach. It lasts only a few minutes.
  • Bone barrow biopsy
    During this procedure the physician will acquire a piece of bone and bone marrow from the back of your pelvic bone by inserting a hollow needle. The test is somewhat more aggressive compared to the bone marrow puncture and gives a more accurate assessment of the percentage of cancer plasma cells in the bone marrow.
  • Bone damage
    Multiple myeloma can cause damage to the bones and that is why bone tests should be carried out (imaging diagnostics) which are completely painless. Signs of osteoporosis, former and recent bone fractures or changes in the bone composition will be found. These tests are crucial for treatment-method planning and, later, for the disease progress monitoring.
  • Skeletal survey
    Skeletal survey is carried out to determine whether or not any changes typical to the disease have occurred on the bones, or if there is any bone damage present. Black spots on the x-rays point to diseased bone area. This could mean osteoporosis, osteolytic changes of the bones (localized osteoporosis areas), collapse, injuries to the vertebra and pathological fracture. Unfortunately, this diagnosis method only shows damage, when it has already progressed.
  • MRI and CT scan

    If no changes to the bones are recorded with normal skeletal surveys, MRI and CT scans are carried out to determine presence and extent of multiple myeloma. These scans also give a more accurate definition of pathological changes of the bones when necessary. By performing MRI and CT scans we get information that is both more useful and more precise to that of skeletal surveys. Bone lesions which could put pressure to the spinal cord are detected when clinical suspicion arises. 

    Special PET/CT scanning gives information on active bone lesions and localized multiple myeloma outside the bone marrow, but this procedure is rarely used with patients suffering from multiple myeloma. It is also used to assess the treatment efficacy.

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