Paraproteinemia and multiple myeloma
North South North West Statewide
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
- Renal function
- Xray of areas of suspicion
- Consider bone scan
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.
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.
Proceed to Emergency Department (ED).
LGH ED Reception – Phone: (03) 6777 6405 Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120 Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100 Fax: (03) 6173 0489
Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.
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
Triaged by medical staff and generally seen in the next six to eight weeks
Triaged by medical staff and given the next available appointment