# Multiple myeloma (plasma cell myeloma) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.03 - condition scope only, no dose · Multiple Myeloma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK534764/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Multiple myeloma (plasma cell myeloma) - disease-level clinical article (multiple-myeloma-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text MULTIPLE MYELOMA (PLASMA CELL MYELOMA) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.03 - condition scope only, no dose · Multiple Myeloma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK534764/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Multiple myeloma (plasma cell myeloma) - disease-level clinical article (multiple-myeloma-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - CRAB features - raised calcium, kidney dysfunction, anaemia, or bone pain from lytic lesions - are the classic picture, often in an older adult [anaemia · bone pain] - In one series, anaemia was present in 73%, bone pain in 58%, raised creatinine in 48%, fatigue in 32%, high calcium in 28%, and weight loss in 24% [anaemia · bone pain · fatigue · weight loss] - High calcium from bone breakdown may show up as drinking and urinating more, aching bones or belly, feeling sick, being sick, or confusion [bone pain · confusion · nausea · vomiting] - Anaemia can bring on fatigue, palpitations, and worsening of pre-existing heart failure or angina [anaemia · fatigue · palpitations] - Bone pain from lytic lesions can lead to fractures, vertebral collapse with loss of height, cord compression, radicular pain, or kyphosis [bone pain · collapse] - Peripheral neuropathy or carpal tunnel syndrome is uncommon and should prompt a work-up for coexisting amyloidosis - Rare hyperviscosity symptoms - bleeding, confusion, neurological symptoms, or vision changes - are a medical emergency [bleeding · confusion] - Recurrent infections, especially pneumonia and kidney infection, are more common in these patients [recurrent infections] SIGNS - what you find (1) - Pallor may be seen on exam, reflecting the anaemia from bone marrow replacement [anaemia · pallor] TESTS (11) - Recommended baseline work-up includes a CBC with differential and platelets, kidney and electrolyte panel with calcium, LDH, and beta-2 microglobulin - Serum protein and immunofixation electrophoresis, plus a 24-hour urine protein and urine electrophoresis, are part of the work-up - Bone marrow aspirate and biopsy with cytogenetics, plus plasma cell FISH testing, complete the work-up - The classic diagnosis needed clonal marrow plasma cells at least 10%, or a biopsy-proven plasmacytoma, plus at least one CRAB feature - A serum calcium over 11 mg/dL, or more than 1 mg/dL above the normal upper limit, meets the calcium criterion - Renal insufficiency means a creatinine over 2 mg/dL or a creatinine clearance under 40 mL per minute - Anaemia is defined as haemoglobin under 10 g/dL, or more than 2 g/dL below the normal lower limit - One or more punched-out, radiolucent osteolytic lesions on skeletal X-ray, CT, or PET-CT meets the bone criterion - Under the newer criteria, clonal bone marrow plasma cells at 60% is diagnostic on its own - An involved-to-uninvolved serum free light chain ratio of 100 or more is also diagnostic by itself - An abnormal MRI with more than one focal lesion, each over 5 mm, also meets the newer diagnostic criteria IF NOT THIS - what else fits (5) - MGUS has a serum monoclonal protein under 3 g/dL, clonal marrow plasma cells under 10%, and no end-organ damage - Smouldering myeloma has monoclonal protein at 3 g/dL or more and clonal plasma cells between 10% and 59%, still with no end-organ damage - Solitary plasmacytoma is one clonal-plasma-cell lesion with an otherwise normal marrow, clear imaging elsewhere, and no end-organ damage - Waldenstrom macroglobulinaemia has an IgM protein, unusual in myeloma, plus MYD88 L265P, with hyperviscosity, neuropathy, anaemia, and enlarged nodes or organs - AL amyloidosis brings heart failure, an enlarged liver, or nephrotic syndrome, with under 20% marrow plasma cells, no lytic lesions, and Congo-red staining Source StatPearls "Multiple Myeloma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Needs urgent haematology referral for diagnosis (protein studies, bone marrow) and chemotherapy; GP can offer cautious analgesia (avoiding NSAIDs, which risk worsening the renal impairment common in myeloma) while arranging referral. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Needs urgent haematology referral for diagnosis (protein studies, bone marrow) and chemotherapy; GP can offer cautious analgesia (avoiding NSAIDs, which risk worsening the renal impairment common in myeloma) while arranging referral. Caution RED FLAG - Acute metastatic spinal cord compression (severe new back pain, lower limb motor weakness, sensory level, urinary retention): assess urgently and refer. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Spinal cord compression resulting from vertebral fracture or plasmacytoma is an emergency requiring immediate intervention. RED FLAG - Bone pain or pathological fracture, renal impairment, unexplained anaemia, hypercalcaemia symptoms (confusion, constipation, thirst), or recurrent infections. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)