Plasma Cell Dyscrasias

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INDICATIONS FOR TESTING

Individual signs and symptoms suggestive of
BASELINE SCREENING
 CBC plus differential plasma cell dyscrasia
 Complete metabolic panel
 LDH
ORDER
 Serum protein electrophoresis (SPEP) – quantifies M
protein
 Serum immunofixation electrophoresis (SIFE) –
characterizes M protein
 Serum kappa and FLC ratio
 Urine protein electrophoresis (UPEP) – if primary
amyloidosis is suspected

IgM M protein IgG, IgA, IgD, or IgE M protein

 M protein <3 g/dL

 M protein <3 g/dL  M protein (any size)  M protein ≥3 g/dL AND
 No organ/tissue  ≥10% clonal bone marrow OR  No end-organ
damage plasma cells  Elevated FLC ratio impairment (see
 <10% clonal bone  Evidence of organ/tissue CRAB Features)
marrow plasma cells damage (anemia,
hepatosplenomegaly)
ORDER MGUS
Bone marrow biopsy likely
Waldenström Imaging studies
IgM MGUS
macroglobulinemia

Repeat evaluation
 ≥10% clonal bone  ≥10% clonal bone in 3-6 months
marrow plasma cells marrow plasma
 No myeloma- cells
OTHER DIAGNOSES defining event or  ≥1 myeloma-
CRAB feature defining event or
Solitary Plasmacytoma
CRAB feature
 Single lesion on imaging confirmed by biopsy
showing plasma cells
Smoldering multiple myeloma
 No CRAB features (asymptomatic) Active multiple myeloma
 Normal bone marrow biopsy (symptomatic)
 Normal skeletal survey

Primary Amyloidosis Treat and monitor for

 Amyloid-related systemic syndrome attributed disease
to a plasma cell proliferative disorder
 Positive amyloid staining by Congo red of any
tissue CONSIDER
 Evidence that amyloid is light-chain related  SPEP, UPEP, SIFE, FLC ratio
 Evidence of monoclonal plasma cell  Bone scan
proliferative disorder  Multiple Myeloma Minimum Residual Disease by Flow
Cytometry

Abbreviations
BM Bone marrow
CRAB Calcium (elevated), renal insufficiency, Myeloma-Defining Events
anemia, bone lesions  Clonal bone marrow cells ≥60%
CT Computed tomography  Serum involved:uninvolved FLC ratio of ≥100
FLC Free light chain  >1 focal lesion on MRI ≥5 mm
LDH Lactate dehydrogenase CRAB Features
MGUS Monoclonal gammopathy of  Elevated calcium: serum calcium >11 mg/dL
undetermined significance  Renal insufficiency: serum creatinine >2 mg/dL or creatinine clearance <40 mL/min
MRI Magnetic resonance imaging  Anemia: hemoglobin value <10 g/dL
PET Positron emission tomography  ≥1 lytic lesion on skeletal radiography, CT, or PET-CT
© 2006 ARUP Laboratories. All Rights Reserved. www.arupconsult.com Content reviewed: Jan 2020 Last updated: Jan 2020