2.2 Assessments by the general practitioner
If there is high suspicion of MM after clinical assessment, the general practitioner should promptly
refer the patient to a haematologist or specialist centre to confirm the diagnosis.
In cases where clinical suspicion is lower, general practitioner examinations and investigations should include the following.
Blood test to identify paraproteins and/or elevated light chains that may indicate underlying MM:
- serum protein electrophoresis (SPEP) and immunofixation (IF)
- serum kappa and lambda free light chain (SFLC), and light chain ratio. Blood and urine tests that may indicate end-organ dysfunction:
- full blood count, differential
- creatinine, urea and electrolytes
- liver function tests, calcium, magnesium, phosphate, urate
- urine dipstick full ward test to look for
X-ray or computed tomography (CT) imaging of painful areas to assess for fractures, lytic lesions and/or soft tissue plasmacytomas may also be warranted.
When moderate or severe symptoms are present in MM as a differential diagnosis, the general practitioner should review promptly (within two days) to avoid missing a medical emergency such as severe hypercalcaemia, renal failure or spinal cord compression.
In non-urgent cases where investigations are done in general practice, the general practitioner should have results, review the patient and finalise a path of action within four weeks.
