Paraproteinaemia

Last updated: Friday, 21, January, 2011
Key InformationAppropriate Tests
  • FBC, blood film; protein (total) and protein electrophoresis with paraprotein quantitation and typing, immunoglobulins G, A, M , beta-2-microglobulin.
  • Urine - protein, Bence Jones protein.
  • Bone marrow aspiration and trephine biopsy is usually not required in elderly, asymptomatic patients with small paraproteins (<10 g/L), no bone lesions, or evidence of bone marrow or other organ failure.

See Table 2 Reference intervals for immunoglobulins G, A, M (g/L)

Causes

Waldenström macroglobulinaemia

Lymphoma (non-Hodgkin's)

Heavy chain disease

Primary Amyloidosis

Monoclonal gammopathy of uncertain significance (MGUS)

Smouldering multiple myeloma

See Multiple myeloma

Multiple myeloma

Presentation

Hyperviscosity

See Hyperviscosity syndrome

Renal failure

Bleeding

See Bleeding disorders
  • Platelet dysfunction 

Platelet function analysis (PFA100) may be indicated.

  • Disordered fibrin formation 

Thrombin time; reptilase time.

  • Coagulation factor inhibitor 

PT/INR, APTT; coagulation factor inhibitors.

Peripheral neuropathy