Testing for Multiple Myeloma
There are a number of tests that are done to determine the extent and trend of multiple myeloma. These include the following:
- Blood tests
These tests look at specific blood tests, including kidney function, calcium and protein levels (details are lower on this page)
- Bone marrow biopsy and aspiration
A needle is used to extract bone marrow. This is done in the pelvic bone where there are large bones and minimal damage to any internal organs
A local anesthetic or a more general anesthetic is usually given.
- 24 hour urine sample
Collect urine for 24 hours to detect M proteins (also known as Bence Jones proteins).
Assess kidney function
- Bone scan X-ray to determine the damage to bones
- Positron Emission Tomography: PET scan, to detect extent of multiple myeloma
- Computed Tomography: CT or CAT scan
- Magnetic Resonance Imaging: MRI
Blood Tests
CBC (Complete Blood Count)
IgA, IgD, IgE, and IgG as well as Kappa versus Lambda type: are determined by serum or urine IFE (immunofixation). Each myeloma patient typically has one predominant Ig type, either IgA, IgG, and IgM. As well as either kappa or lambda light chains.
Calcium and creatinine: are determined by a metabolic panel
Free light chain ratio (ratio of kappa to lambda): is determined by serum FLC assay. The ratio of kappa to lambda is more important than the exact amount of each.
| Complete Blood Count: (CBC) | Normal Range |
White Blood Count (WBC) There are five main types of white blood cells (see below):
|
3.8 - 10.5 K/uL |
| Neutrophils, the most abundant white blood cell. They defend against bacterial or fungal infection. | |
| Lymphocytes, B cells (make antibodies), T cells (Some T cells directly attack virus infected cells or cancer cells and destroy them, while other T cells produce proteins that help regulate the immune system), Natural Killer (NK) cells that kill foreign invaders | |
| Monocytes, share the function of neutrophils, but are much longer lived and they present pieces of pathogens to T cells so that the pathogens may be recognized again and killed. | |
| Eosinophils, primarily deal with parasitic infections and also are the predominant inflammatory cells in allergic reactions. | |
| Basophils, responsible for allergic and antigen response by releasing the chemical histamine causing the dilation of blood vessels. | |
| Red blood cell Count (RBC) | 4.4 - 5.8 M/uL |
| Hemoglobin, total amount of the oxygen carrying protein | 13.6 - 17.2 g/dL |
| Hematocrit, the percentage of total blood volume that consists of red blood cells | 40% - 52% |
| Comprehensive Metabolic Panel | Normal Range |
| Sodium |
135 - 144 mmol/L |
| Potassium | 3.5 - 4.8 mmol/L |
| Chloride | 97 - 106 mmol/L |
| Carbon Dioxide | 22 - 32 mmol/L |
| Anion Gap | 7 - 14 mmol/L |
| Glucose | 70 - 99 mg/dL |
BUN, Blood Urea Nitrogen, is an indication of renal or kidney health. An increase in BUN are due to a high protein diet or a decrease in eGFR, glomerular filtration rate. |
7 - 20 mg/dL |
| Creatinine | 0.70 - 1.20 mg/dL |
| e-GFR (Estimated Glomerular Filtration Rate) an important kidney test. Wikipedia article for details. | 60 - 120 mL/min/1.73sqm |
| Bilirubin, waste product produced by the liver as it breaks down and recycles aged red blood cells. It is excreted in bile and urine, and elevated levels may indicate certain diseases. | 0.0 - 1.4 mg/dL |
| Calcium | 8.5 - 10.2 mg/dL |
Alkaline Phosphatase, is a hydrolase enzyme responsible for removing phosphate groups from many types of molecules, including nucleotides, proteins, and alkaloids. Elevated levels in the blood are most commonly caused by liver disease or bone disorders. |
40 - 150 U/L |
| AST/SGOT, (aspartate amino transferase) - enzyme found especially in cells in the heart and liver; also a useful test for detecting liver damage. | 5 - 34 U/L |
| ALT/SGPT, (alanine amino transferase) - enzyme found mostly in the cells of the liver and kidney; a useful test for detecting liver damage. | 0 - 55 U/L |
Albumin, a small protein produced in the liver; the major protein in serum |
3.5 - 5.0 g/dL |
| Total Protein, measures albumin as well as all other proteins in serum | 6.4 - 8.3 g/dL |
| Immunoglobulins A, G, M (also called antibodies, proteins produced by plasma cells) | Normal Range |
| iGA - a class of antibodies predominant in respiratory and alimentary tract secretions and in saliva and tears, functioning as the body's first line of defense against invading foreign substances. | 101 - 645 mg/dL |
| igG - produced by plasma cells and memory cells in response to pathogens and other foreign substances. Provides long lasting defense against most bacterial invasions and other antigens. | 540 - 1822 mg/dL |
| igM - a class of short-term circulating and secretory antibodies having a high affinity for viruses. It is the first or primary immunoglobulin produced following exposure to an antigen. | 22 - 240 mg/dL |
| Kappa/Lambda Free Light, associated with Immunoglobulins | Normal Range |
| Kappa | 0.33 - 1.94 mg/dL |
| Lambda | 0.57 - 2.63 mg/dL |
| Kappa/Lambda Ratio | 0.26 - 1.65 |
For more blood test details:
Lab Tests Online (Complete Blood Count CBC)
Lab Tests Online (Comprehensive Metabolic Panel)
Lab Tests Online (eGFR)
Lab Tests Online (Immunoglobulins A, G, M)
Lab Tests Online (Kappa/Lambda Free Light)
Links
Mayo Clinic testing
Myeloma protein (Wikipedia)
Multiple Myeloma Research Foundation, diagnostic tests
eMedicine Health, diagnostic tests
Wikipedia (white blood cells)
Wikipedia (light chains)
