Myeloma investigations
18th March 2022
The following tests are relevant when investigating suspected myeloma:
- Full blood count to look for anaemia or leukopenia
- Renal profile to look for renal dysfunction
- Bone profile to look for evidence of hypercalcaemia, plasma viscosity or ESR to look for inflammation
- Bence-Jones protein urine assessment
- Serum protein electrophoresis
Bence-Jones protein urine assessment and serum protein electrophoresis
If you are suspicious of myeloma following receiving blood test results, it useful to request both a Bence-Jones protein test and serum protein electrophoresis test. A combination of these assessments will diagnose up to 95% of patients. If you test for serum protein electrophoresis alone, you will identify only 2/3 of patients. However, it is important to note that both of these tests are negative in 1-2% of people with multiple myeloma, who have a ‘non-secretory’ form of the disease that produces no serum M protein or urinary Bence-Jones protein.
According to NICE NG12 guidelines, serum protein electrophoresis and a Bence-Jones protein urine test to assess for myeloma should be offered within 48 hours to people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma. If a patient’s investigation results show abnormalities or appear to indicate myeloma then this should be investigated further by a specialist. A suspected cancer referral should be made for an appointment within 2 weeks.
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