If you are suspicious of myeloma following blood results, there are two pertinent investigations that can be ordered in primary care to give a strong case for referral:
1. Serum protein electrophoresis test
2. Bence-Jones protein urine test
If you test for serum protein electrophoresis alone, you will identify only 2/3 of patients.
Most patients with untreated myeloma have a monoclonal immunoglobulin peak in serum, urine, or both. A combination of serum protein electrophoresis and Bence-Jones protein urine test will diagnose up to 95% of patients with myeloma without any form of imaging. NICE NG12 guidelines suggest making a suspected cancer referral for patients whose investigation results indicate myeloma.
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