Once studied the symptoms and tests carried out, if they are suggestive of a possible case of myeloma, are often make a series of blood and urine analysis, including more specific determinations, as well as x-ray tests and an aspiration and biopsy of bone marrow, among other tests.
1. Blood count full blood tests.
With the realization of a complete blood count levels of red blood cells, white blood cells, and platelets in blood are observed. As mentioned in the previous module, if the levels of these plasma cells are low you can due to the mielomatosas cells are moving and occupying the place in the bone marrow which should deal with the normal plasma cells.
Cell counts are important for the following reasons:
- The number of white blood cells indicates doctors the risk of infection by a patient.
- The level of hemoglobin, the red blood cells, notifies physicians of a possible state of anemia.
- The number of platelets explains the propensity of the patient to slow blood clotting, and the appearance of bruising easily.
2. Measurement of the paraprotein
Similarly, at diagnosis and throughout treatment collect blood samples from the patient on a regular basis. As you have seen above, samples of blood and urine are used to measure the level of paraprotein in the same.
Changes in the levels of evidence, in addition to being an indicator of the presence of a myeloma, are also very useful to check changes in the activity of myeloma, so through this test can reveal if the treatment is working or not, and if it stays stable (plateau phase) or there is a relapse.
The plateau phase name comes from graphic of the results of paraprotein observation, since the levels are usually flat development that looks like a plateau in the graph. Both the level and the duration of response are important when it comes to measuring the success of a treatment.
Complete remission is very rare except after very intensive treatments and stem cell transplants.
The serum protein electrophoresis measures the amount of immunoglobulin in blood, and detects those abnormal inmonoglobulinas, such as the monoclonal immunoglobulin produced by cells mielomatosas, as a “monoclonal peak”.
Once determined the existence of abnormal immunoglobulins, should determine which type they are. That is achieved through the immunofixation and immunoelectrophoresis, which determines the exact type of immunoglobulin or paraprotein (as it has been in previous modules, the most common are IgG or IgA, and kappa type).
The tests used to find a monoclonal immunoglobulin in the urine are called protein in urine (UPEP) and urine immunofixation electrophoresis.
4. Free light chains
Through this test measured the amount of light chains of immunoglobulins in the blood (one of the parties which composed the paraprotein, seen in module 2). There are cases of myeloma in which this component of myeloma by electrophoresis is not detected. This is due to the blood protein electrophoresis measuring intact immunoglobulin levels but not free chains.
5. Beta 2 Microglobulin
A blood test can also be useful for detecting levels of a molecule called Beta 2 microglobulin (? 2M). The? 2M is another protein in the plasma produced by mielomatosas cells. Although this molecule itself does not cause problems, it is one of the most important indicators of the activity of myeloma and is therefore crucial to determine the prognosis of each individual case.
6. Other chemical tests of the blood
- Renal function:
Kidney function may be affected by own myeloma and its complications, as well as other unrelated causes, and some of the effects of the treatment.
Blood tests are also conducted to delineate levels of nitrogen from urea in the blood (BUN) and creatinine (Cr), both waste products, which are normally filtered through the kidney. High blood levels of the above compounds indicate a poorly functioning kidney.
Albumin is a type of protein produced by the liver. Normally forms the greater part of protein in blood, but in patients affected by myeloma, however, hormones (cytokines) produced by the same myeloma (mainly Interleukin 6) suppress the production of this protein. Therefore, a low level of albumin may indicate an advanced stage of myeloma and is an indicator of worse prognosis
- Measurement of calcium:
Calcium is a mineral that normally found in bone. Those patients who develop active fault of myeloma bone disease, shows a release of calcium from bone to blood flow which can lead to excessive levels of calcium in the blood, which is called hypercalcemia.