Multiple Myeloma and Monoclonal Gammopathies C - HyperCalcemia- calcium > 11 mg/dL / >1 mg/dL the ULN R - Renal disease - Cr >2 mg/dL or CC < 40 ml/min A - Anemia- Hemoglobin < 10 g/dL or <2 g/dl LLN B - Bony lesions +1 or more: • Clonal bone marrow plasma cell percentage ≥60% • Involved: uninvolved serum free light chain ratio ≥100 • >1 focal lesions on MRI studies Look for gamma gap (total protein - albumin) ≥ 4 to identify hypergammaglobulinemia; SPEP determines if this is is monoclonal or polyclonal. Causes of false- negative SPEP: • Non-secretory MM (1-2% of MM), light chain deposition disease, and amyloidosis Other causes of a monoclonal M spike: • CML, B and T cell lymphoproliferative diseases, CML, amyloidosis, solitary plasmacytoma, POEMs syndrome, Castleman's, Waldenström's macroglobulinemia, and autoimmune diseases. Dr. Ann Marie Kumfer @AnnKumfer #MultipleMyeloma #Monoclonal #Gammopathies #MGUS #diagnosis #hematology #oncology
