Multiple Myeloma - Diagnosis

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Describe the tests and exams that led to a diagnosis of multiple myeloma.

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How do health-care professionals diagnose multiple myeloma?

In many patients, multiple myeloma is first suspected when a routine blood test shows an abnormal amount of protein in the bloodstream or an unusual stickiness of red blood cells causing them to stack up almost like coins in a pattern called rouleaux, an unusual formation for red blood cells. The doctor will do a history and physical exam, looking for signs and symptoms (see above) of multiple myeloma. If multiple myeloma is suspected, several studies help confirm the diagnosis. They include a bone marrow aspiration and biopsy most commonly from the large bones of the pelvis. Cells obtained from the marrow are studied by a pathologist to determine if there are abnormal types or numbers of cells. A sample of the bone marrow aspirate is also studied for more detailed characteristics such as the presence or absence of abnormal numbers or types of chromosomes by what is called cytogenetic testing. Other molecular testing may be done on the marrow sample as well. The bone marrow biopsy can assess the concentrations of cells in the marrow and the presence of abnormal invasive growth of cellular elements. Blood testing and urine testing by several methods can determine levels and types of monoclonal protein produced. The M protein may be a complete form of a type of antibody called an immunoglobulin or only a portion of the protein called a light chain. Normal antibodies consist of both heavy and light chain components. In 2011, the National Comprehensive Cancer Network (NCCN) recommended that a serum free light chain assay and fluorescence in situ hybridization (FISH) test be used to further identify multiple myeloma in patients. Most clinicians will use X-ray studies to identify skeletal lesions and MRI for spinal, paraspinal, or spinal cord lesions in multiple myeloma. In addition, several routine tests (CBC, sedimentation rate, BUN, C-reactive protein, and others) are also done.

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Comment from: Hansd, 75 or over Male (Patient) Published: February 06

My doctor suspects multiple myeloma from blood tests done recently. For 4 days I had been tired when walking and then I fainted in the bathroom, was taken to emergency and received 3 bags of blood. This brought the hemoglobin level up from 55 to 91. Further tests are now being done (blood, urine and skeletal X-ray to determine what the further treatment should be. I am 90 years old and consider myself healthy (never had any major disease). For 30 years I have worked out at a fitness center and walk 2 times for 20 minutes each day. I am interested in knowing what further to expect.

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Comment from: BO, 45-54 Male (Caregiver) Published: June 04

My husband had been working on our daughter"s truck, changing and rotating tires. He had a difficult time working some of the bolts loose. The next week, he began having lower back pain that became increasingly worse, to the point he was having difficulty walking. After a trip to urgent care where they did an x-ray and suggested that he see a chiropractor, he followed up with an orthopedist instead. After a month of unsuccessful treatment with a dose pack, unsuccessful physical therapy and increasing pain, they prepared to do an epidural steroid injection (ESI) with and MRI. That"s when they found the tumor on his T10 that was "highly suggestive" for multiple myeloma. He was hospitalized the next day and had the CT, bone scan, blood work and bone marrow biopsy for the definitive diagnosis.

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