Indications directory

Differential diagnosis:

1. Myeloma
2. Monoclonal gammopathy of unknown significance (MGUS, very common: approximately 1 % at age 50+ and up to 10 % at age 75 and above). Usually < 10 % plasma cells in the bone marrow, < 3000 mg/dl myeloma protein in the serum, no Bence-Jones-protein in the urine, no anemia, no kidney failure, no lytic bone lesion, no hypercalcemia. During the long-term progress, approximately 25 % of patients with MGUS develop a myeloma.

Specific evidence:

Immune fixation in the serum and urine, free light chains in the serum

Basic evaluations:

Blood: ESR, CRP, full blood count, calcium, AP, creatinine, urea, uric acid, beta-2-microglobuline, cold agglutinin, cryoglobulines

Urine: Urine-protein-SDS-electrophoresis, if necessary total protein in the 24-hour urine, creatinine clearance

Histology: Bone marrow biopsy with cytology and histology