![]() The clinical presentation of multiple myeloma can be extremely varied. How can multiple myeloma and MGUS present? Multiple myeloma Usually required to confirm a diagnosis of multiple myelomaĪ small proportion of cases may be non-secretory with undetectable paraprotein No clear explanation including pre-renal causes, primary renal disorders or obstructive conditions No history of malignancy, sarcoidosis or use of medications such as thiazides ![]() Parathyroid hormone appropriately suppressed ![]() No clear alternative explanation such as renal impairment or anaemia of chronic disease Vitamin B12, folate and iron studies normal When should a diagnosis of myeloma be considered? Finding Monoclonal gammopathy of undetermined significance is defined as a serum paraprotein of 30 g/L or a bone marrow plasmacytosis of >10% ( Table 1). MGUS and smouldering myeloma are asymptomatic with no evidence of end organ damage. Trephine showing infiltration with malignant plasma cells
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