How myeloma is diagnosed

At the hospital you’ll see a specialist who will ask about your general health and any previous medical problems. They will examine you physically and arrange a series of tests including x-rays of the bones, bone marrow biopsies and blood and urine tests.

Blood tests Back to top

Blood tests are an important way to diagnose and monitor myeloma. Tests on your blood will include:

• Serum protein electropheresis This is the main blood test used to diagnose myeloma. It measures the amount of abnormal antibodies (paraproteins) in the blood. This test is also used as a guide to see how well treatment is working.
• Full blood count This measures the levels of white cells, red cells and platelets. If any of the levels are low this can show your doctor how your bone marrow has been affected by myeloma.
• Urea and electrolytes This test gives information on how well your kidneys are working.
• Calcium level This measures the level of calcium in the blood - it’s sometimes raised in myeloma.
• Beta-2 microglobulin A protein produced by myeloma cells. This test can help tell how active a myeloma is.
• Albumin levels Albumin is a protein found in the blood. A low level of albumin can indicate an advanced myeloma.
• Serum free light chain analysis (Freelite™) This test can detect very small levels of light chains and is useful for diagnosing and monitoring Bence Jones and non-secretory myelomas.

Urine samples may also be taken to test for the Bence Jones protein. You may need to take a container home and collect your urine for 24 hours. The nurses will explain more about how to do this test.

Bone marrow sample Back to top

If there are paraproteins in your blood or urine, your doctor will want to take a bone marrow biopsy. A sample of bone marrow is usually taken from the back of your hipbone (pelvis) or, sometimes, the breast bone. It is then examined to see if it contains any myeloma cells.

The bone marrow sample is taken under a local anaesthetic. You’ll be given a small injection to numb the area and the doctor gently passes a needle through your skin into the bone. The doctor draws a small sample of liquid marrow into a syringe (a bone marrow aspirate) to be looked at later under the microscope. The doctor will then take a small core of marrow from the bone (a trephine biopsy).

The test can be done on the ward or in the outpatients department. The whole procedure takes about 15-20 minutes. It may feel uncomfortable while the marrow is drawn into the syringe but this should only last a few seconds. You may be offered a medicine to make you feel drowsy and help to reduce any pain or discomfort during the test. You may feel bruised after the test and have an ache for a few days. This can be eased with mild painkillers.

Cytogenetics Back to top

Each cell in the body contains chromosomes, which are made up of genes. Genes control all activities of the cell. In myeloma there may be changes in the structure of the chromosomes within the myeloma cells, but not the normal cells of the body. Tests on the bone marrow samples will look for changes in the chromosomes.

These tests, known as cytogenetic tests, may help to decide on the best treatment and predict how well the myeloma may respond to that treatment. A test called fluorescence in situ hybridisation (FISH) is used to detect specific changes to the chromosomes of the myeloma cells.

X-rays and scans Back to top

X-rays will be taken to check for any possible damage to the bones from the myeloma cells called lytic lesions. You’ll usually have x-rays taken of your whole body, which is known as a skeletal survey. Although x-rays and scans are not painful, you may find lying on a hard surface for long periods of time uncomfortable. Ask your doctor, nurse or radiographer for a painkiller if you need one.