True about Multiple myeloma are all Except: (PGI May 2010)
|A||Bence Jones protein in urine|
Other investigations are:
1. Renal function tests (blood urea, creatinine, electrolytes)
2. Blood calcium and albumin (hypercalcemia)
3. Bone scan is normal
4. Plasma Ig level (degree of immune paresis)
5. Serum β2 microglobulin. It is the single best parameter to tell about poor prognosis.
6. ESR is highly raised.
7. CRP & ↑ IL-6 (CRP is a surrogated marker of IL-6, which is referred as Plasma Cell growth factor)
8. Plasma cell - a. Increase Acid phosphate b. Increase Glucuronidase
9. Pseudohyponatremia occurs.
10. Anion gap is less than normal.
11. Beta –2 microglobulin level are the single most important poor prognostic factor.
Extra Edge: (Ref. Hari-18th ed., Pg.- 939)
i. Patients with myeloma also have a decreased anion gap [i.e., Na+ – (Cl– + HCO3–)] because the M component is cationic, resulting in retention of chloride
ii. Normal relative serum viscosity is 1.8 (i.e., serum is normally almost twice as viscous as water). Symptoms of hyperviscosity occur at a level greater than 4 centipoise (cP), which is usually reached at paraprotein concentrations of 40 g/L (4 g/dL) for IgM, 50 g/L (5 g/dL) for IgG3, and 70 g/L (7 g/dL) for IgA.