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Possible multiple myeloma????
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Possible multiple myeloma????

I am a 48 y.o female who was being tested for signs and symptoms of hyperparathyroidism.  I had several repeat blood tests that came back with elevated calcium and protein but normal PTH.  My physician ordered a 24 hour urine and additional blood tests.  My results are as follows:  Protein / Creatinine ratio 294 (range is 21-161 and total protein of 42 (range is 5 -24).  My Vitamin D (OH) level was low at 17 (range 18 - 72).  With protein electrophoresis it showed Beta Globulins at 3.2 High (range is 0.8 - 1.4) and abnormal protein band 1 at 0.2 high (range should be none detected).  The interpretation read two possible monoclonal bands present.  Beta M-Spike = 2.1 g/dL and the second in the gamma region.  I have been told they are looking at possible multiple myeloma.  Would you agree and what additional tests will or should be performed?  Could this be something else?  Thank you in advance.
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Phelpsda,

From the results that you have described so far, the findings are concerning for a plasma cell disorder (such as multiple myeloma) or a lymphoproliferative disorder (such as Waldenstrom's macroglobulinemia).  The difference between these two depend upon the type of monoclonal protein that is present (IgM is typically the abnormal protein found in Waldenstrom's macroglobulinemia).  

Although there are other things that can occasionally cause false positive findings, or that can be associated with the presence of detectable monoclonal proteins, your history of elevated calcium and protein levels, protein in your urine, detectable monoclonal proteins in your serum, make one of the above diagnoses much more likely (particularly multiple myeloma).

It is important to characterize the type of monoclonal protein present (whether IgG, IgA, IgM, etc and whether they are kappa or lambda related).  Serum free light chain studies and B2-microglobulin levels are also helpful information.  Additional blood testing includes laboratory studies for kidney function and also complete blood count evaluation. Other studies that will be necessary to confirm diagnosis include a bone marrow biopsy and a skeletal survey (plain-film x-rays of all the bones in your body).  

If multiple myeloma is confirmed, it is a treatable disease.  And there are many different effective treatment options. Good luck.
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