Multiple myeloma - interdiscipline diagnostic problem
Multiple myeloma (MM) is an uncurable plasma cell malignancy, with incidence approximately 4 per 100 000 population and rich symptomatology causing often significant diagnostic problems. In 1992-2004 in Haematology Department of Medical University in Lublin MM was diagnosed in 197 patients (110 woman and 87 men, mean age 61± 11.2 years). The most common monoclonal protein type of was IgG, detected in 133 patients. At the time of initial diagnosis in 138 patients bone pain was a main complain, in 10,2% of these patients it was caused by pathological fractures. In 20 patients (10.2%) clinical course was indolent, and disease was diagnosed accidentally. In the other patients first clinical manifestation were unspecific symptoms, such as: general weeknes (15/197 patients), paraparesis (9/197), acute renal failure (8/197), prolonged infections (8/197) bone of soft tissue tumours (7/197). Taking into account unspecific clinical picture preliminary diagnostics should focus on characteristic for MM laboratory features, i.e.: highly accelerated erythrocyte sedimentation reaction resulted from hyper- and para-proteinaemia; proteinuria; osteolytic lesions in bone radiograms. Lack of appropriate diagnostic strategy prolongs time to therapy commencement to 5.3±4.7 months, in some cases even to 24 months. On the level of basic health care total protein serum level and bone radiograms are adequate diagnostic investigation to establish preliminary diagnosis of MM. In our study increase of total protein serum level and characteristic changes in bone radiograms were found in 96% of patients.