{"id":2549,"date":"2023-01-24T11:17:01","date_gmt":"2023-01-24T11:17:01","guid":{"rendered":"https:\/\/papergp.com\/?page_id=2549"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"paraproteins-and-myeloma-testing-in-primary-care","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/fbc-2\/paraproteins-and-myeloma-testing-in-primary-care\/","title":{"rendered":"Paraproteins and Myeloma Testing in Primary Care"},"content":{"rendered":"\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p><a href=\"https:\/\/gps.northcentrallondon.icb.nhs.uk\/pathways\/abnormal-fbc-results-1\">NCL ICB pathway<\/a><\/p><\/blockquote>\n\n\n\n<p>Paraproteins: an abnormal protein in the blood or urine &#8211; secreted by a blood malignancy<\/p>\n\n\n\n<p>Myeloma &#8211; a blood cancer associated with anaemia, renal impairment, hypercalcaemia, bone lesions.<\/p>\n\n\n\n<p>MGUS &#8211; common in older patients. Precursor condition that can transform into myeloma. Around 1% transformation rate per year. Usually only monitored.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Why check blood and urine for paraproteins?<\/h2>\n\n\n\n<p>Intact immunoglobulins are detected using Serum Protein Electrophoresis<\/p>\n\n\n\n<p>Lightchains are detected by Urine Protein Electrophoresis (Bence Jones Protein) &#8211; although recently can also be detected in serum as Serum Free Light Chain (SFLC)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How do you interpret SFLC?<\/h2>\n\n\n\n<p>If both Kappa and Lambda light chains are elevated, this is usually due to renal impairment, infection or inflammation &#8211; this does not require haem review.<\/p>\n\n\n\n<p>If only one the types is elevated, this represents a potential haematological issue.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Someone does paraprotein investigations &#8211; how do I interpret the results?<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Low level paraproteins without evidence of end organ damage<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Normal protein electrophoresis, SFLC ratio &lt;0.2 or &gt;3.0 <ul><li>possible high risk MGUS &#8211; routine haematology referral<\/li><\/ul><\/li><li>Abnormal protein electrophoresis (IgG paraprotein &lt;15g\/l or non IgG paraprotein &lt;10g\/l) + abnormal SFLC ratio<ul><li>possible high risk MGUS &#8211; routine haematology referral<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Normal protein electrophoresis, SFLC ratio 0.2-0.3 or 2.0-3.0<ul><li>low risk MGUS or renal\/inflammatory disorder &#8211; monitor MGUS in primary care (FBC, U+E, calcium, serum protein electrophoresis and SFLC\/urine protein electrophoresis every 6 months) and ask about any new bone pain or recurrent infections<\/li><\/ul><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Abnormal protein electrophoresis (IgG paraprotein &lt;15g\/l or non IgG paraprotein &lt;10g\/l) + normal SFLC ratio<ul><li>low risk MGUS or renal\/inflammatory disorder &#8211; monitor MGUS in primary care (FBC, U+E, calcium, serum protein electrophoresis and SFLC\/urine protein electrophoresis every 6 months) and ask about any new bone pain or recurrent infections<\/li><\/ul><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Consider advice and guidance if<ul><li>SFLC rising\/falling significant but still within 0.1 &#8211; 10<\/li><li>Two consecutive increases in >25% in paraprotein of at least 5g\/l<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">When to refer as two week wait to haematology?<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>High paraprotein levels without evidence of end organ damage<ul><li>&gt; 15g\/l IgG paraprotein<\/li><li>&gt; 10g\/l IgA or IgM paraproteins<\/li><li>&gt; 10 SFLC ratio<\/li><li>&lt; 0.1 SFLC ratio<\/li><li>Free Kappa or Free Lambda &gt;100g\/l with any abnormal Kappa\/Lambda ratio<\/li><li>IgD or IgE paraprotein<\/li><\/ul><\/li><\/ul>\n\n\n\n<p>&#8211;&gt; Refer as 2-week wait to haematology<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Raised paraprotein and evidence of end organ damage<ul><li>Bloods<ul><li>Low Hb<\/li><li>Low platelets<\/li><li>Low neutrophils<\/li><li>Lowering eGFR<\/li><li>Raised calcium<\/li><\/ul><\/li><li>B symptoms<ul><li>Weight loss<\/li><li>Fevers<\/li><li>Night sweats<\/li><\/ul><\/li><li>Examination\/radiology<ul><li>Persistent LN enlargement (>1cm)<\/li><li>Splenomegaly (>15cm)<\/li><li>X-ray showing lytic bone lesions<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p>&#8211;&gt; Refer as 2-week wait to haematology<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>NCL ICB pathway Paraproteins: an abnormal protein in the blood or urine &#8211; secreted by a blood malignancy Myeloma &#8211; a blood cancer associated with anaemia, renal impairment, hypercalcaemia, bone lesions. MGUS &#8211; common in older patients. Precursor condition that can transform into myeloma. Around 1% transformation rate per year. Usually only monitored. Why check &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/fbc-2\/paraproteins-and-myeloma-testing-in-primary-care\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Paraproteins and Myeloma Testing in Primary Care<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1301,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2549","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2549","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=2549"}],"version-history":[{"count":3,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2549\/revisions"}],"predecessor-version":[{"id":2553,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2549\/revisions\/2553"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1301"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=2549"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}