Differential Diagnosis
Multiple myeloma
Waldenstrom macroglobulinemia
Monoclonal gammopathy of unknown significance (MGUS)
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Low concentration of monoclonal immunoglobulins (LCMI)
Heavy chain disease
Suggested Additional Lab Testing
For multiple myeloma:
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In addition to SPEP followed by immunofixation, quantitative serum immunoglobulin should be performed, because the M component must be greater than3 g/dL in the serum.
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Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells.
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Bone marrow biopsy may be useful to show aggregates of plasma cells in focal or diffuse patterns.
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CBC often reveals a normochromic normocytic anemia.
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Peripheral blood smear often shows RBCs in a stacked or rouleaux formation.
For Waldenstrom macroglobulinemia:
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Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL
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Serum viscosity is usually increased.
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Peripheral blood smear often shows RBC aggregates in a rouleaux formation.
For heavy chain disease:
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Immunofixation reveals the heavy chain as alpha, gamma, or mu.
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Bone marrow examination may be informative.
For MGUS:
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Quantitative determination of the serum M component to demonstrate that an IgG or IgM monoclonal protein is less than 3.0 g/dL or an IgA monoclonal protein is less than 2.0 g/dL, or that a Bence-Jones protein is less than or equal to 1.0 g in a 24-hour urine specimen
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