Paraproteinemia and multiple myeloma


North South North West Statewide

Pre-referral work-up


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


  • 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.


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). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 8302  Fax: (03) 6777 5201
MCH ED – Phone: 0409 867 492  Fax: (03) 6441 5923
NWRH ED – Phone: 0459 848 725  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6101  Fax: (03) 6173 0489 - Discuss with the on call Haematologist/Registrar via switch (03) 6166 8308


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