Diagnostic investigation of Multiple myeloma:

Ans: d (S. electrophoresis) Ref: Harrison, 16th p. Davidson, 20th ed, p. 1052Confused? Option D is definitely better than option A. Eventhough both lytic bone lesions and S. electrophoresis are included in the diagnostic criteria, according to the diagnostic criteria defined by Salmon & Durie, only monoclonal globulin spikes on S. electrophoresis is taken as major criteria. Lytic bone lesion is taken as a minor criteria only.Diagnosis of multiple myeloma (The durie and salmon myeloma diagnostic criteria).The diagnosis of multiple myeloma requires a minimum of one major and one minor criteria or three minor criteria as defined in the Table below.Major criteria1) Plasmacytoma on tissue biopsy2) Bone marrow palsmacytosis with 30% plasma cells3) Monoclonal globulin spike (M protein) on SPEP: IgG>3.5g/dl, IgA > 2.0g/dl. light chain excretion in UPEP > 1 g per 24 hr in the absence of amylodosis.Minor criteria1) Bone marrow plasmacytosis with 10-30% plasma cells2) Monclonal globulin spike present, but lower levels than defined in major criteria3) Lytic bone lesions4) Normal IgM >50 mg/dl. IgA > 100 mg/dl, or IgG >600 mg/dlThe diagnosis of myeloma requires a minimum of one major criteria and one minor criteria (although 1 +a is not sufficient) or three minor criteria that must include a+b.(SPEP-serum protein electrophoresis. UPEP--urine protein electrophoresis)