How is myeloma diagnosed?
Myeloma is diagnosed using information gathered from a number of different tests. These include a physical examination, blood tests, urine tests, a bone marrow biopsy, x-rays and other more specialised bone imaging tests.
The first step in the diagnosis is a simple blood test. This involves a sample of blood from a vein in your arm being sent to the laboratory for investigation. Serum protein and serum electrophoresis are tests carried out to measure the amount and type of paraprotein in your blood.
A full blood count (FBC) or complete blood count (CBC) is a simple blood test that measures the number of red cells, white cells and platelets in circulation and notes their size and shape. This helps to assess how well the bone marrow is functioning and whether or not normal blood cells are being affected by myeloma.
Bone marrow examination
If the results of your blood tests suggest that you might have myeloma, a bone marrow biopsy may be required to help confirm the diagnosis. A bone marrow biopsy involves taking a sample of bone marrow, usually from the back of the hip bone and sending it to the laboratory for examination under the microscope. The bone marrow biopsy may be done in the haematologist’s rooms, clinic or day procedure centre and is usually performed under local anaesthesia with sedation given either by tablet or through a small drip in your arm.
The sample of bone marrow is examined in the laboratory to determine the number and type of cells present and the amount of haemopoiesis (blood forming) activity taking place there. The diagnosis of myeloma is confirmed by the presence of an excessive number of plasma cells in the bone marrow.
Urine electrophoresis is a test used to measure the amount of protein in the urine. You may be asked to collect all of the urine you pass in a 24-hour period so that the amount of light chains you are passing during this period can be measured. This simply involves collecting all the urine you pass during this period into a large container and returning it to the hospital the following day. Your doctor or nurse will supply you with a suitable container for this collection.
These may be conducted to provide information on your general health and how your vital organs are functioning. These include a combination of further blood tests and imaging tests (x-rays, scans and ECG). These results will provide a baseline of your disease and general health which will be compared with later results to assess how well you are progressing and responding to treatment.