Paraproteinemia and multiple myeloma

Availability

North South North West Statewide

Pre-referral work-up

History

The diagnosis of multiple myeloma requires the presence of a malignant plasma cell population (evidenced on bone marrow biopsy or plasmacytoma) AND demonstrable end-organ dysfunction

All referrals should comply to referral standards and include in particular:

  • Relevant investigations, including previous results to assess temporal pattern
  • Evidence of end-organ damage

Tests

  • Calcium
  • Renal function
  • FBE
  • Xray of areas of suspicion
  • Consider bone scan

Interim/GP management

To refer a patient with this condition, please see the Haematology clinic page for the full referral process and templates.

In the presence of a paraprotein, assessment for end-organ dysfunction (CRAB - see below) is critical in the diagnostic algorithm, and the following assessments should be enclosed:

  • C – Hypercalcaemia
  • R – Renal impairment (without other cause)
  • A – Anaemia/other cytopenia (without other cause)
  • B – Bone lesions (lytic lesions, pathological fracture, unexplained osteoporosis)

For more information please see the Tasmanian Health Pathways website.

Emergency

Suspected spinal cord compression (pain and neurological symptoms) in a patient with known or suspected multiple myeloma.

Impending pathological fracture (radiologically identified) in a patient with known or suspected Multiple Myeloma

Significant hypercalcaemia >2.9 mmol/L

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489 - Discuss with the on call Haematologist/Registrar via switch (03) 6166 8308

Urgent:

Urgent Referrals generally need to be seen in the next one to two weeks

Please discuss these with the Haematology Registrar/Haematologist on call via switchboard on 6166 8308

Semi-urgent:

Triaged by medical staff and generally seen in the next six to eight weeks

Routine:

Triaged by medical staff and given the next available appointment