Back pain and fractures, are they caused by "crab disease"? This blood indicator is a "super detective" that can find the culprit!

Multiple myeloma, commonly known as "crab disease" and "bone-eating disease", has complex and diverse clinical manifestations and a high misdiagnosis rate.

Some patients were admitted to the orthopedics department due to osteoporosis, to the nephrology department due to low back pain, to the oncology department due to bone pain... After many twists and turns, they were finally transferred to the hematology department.

It wastes a lot of physical strength, energy and financial resources, delays treatment, and even causes disability or death.

So what means can be used to diagnose and treat this disease early?

Today, let us learn about its key indicators and the "super detective" in the blood report form - monoclonal immunoglobulin disease!

1. What is Multiple Myeloma?

Mr. Weng was healthy on weekdays. Last weekend, after playing with his grandson, he felt dull pain in his chest and back, and his movements were restricted. At first, he thought he had accidentally strained his back, but after resting, the pain not only did not ease, but became more and more severe. His family immediately sent him to the hospital for examination. The CT scan results showed that Mr. Weng had multiple low-density lesions on both sides of the ribs of the thoracic spine and a mild compression fracture of the T6 vertebra.

Did Mr. Weng really just have a simple fracture?

During the treatment, the doctor noticed Mr. Weng's test report, which showed that Mr. Weng's serum globulin was abnormal, and monoclonal immunoglobulin (M protein) appeared in the serum protein electrophoresis test .

After bone marrow puncture and biopsy, and flow cytometry testing, Mr. Weng was diagnosed with multiple myeloma .

Multiple Myeloma (MM), also known as "crab disease", is a malignant plasma cell disease characterized by abnormal proliferation of bone marrow plasma cells accompanied by excessive production of monoclonal immunoglobulins or light chains (M proteins). Its main symptoms are hypercalcemia, renal impairment, anemia and bone disease.

II. Relationship between Multiple Myeloma and Monoclonal Gammopathy

Multiple myeloma is the most common type of monoclonal immunoglobulin disease that we are going to introduce today. M protein is the hallmark product of monoclonal immunoglobulin disease.

Don’t panic when M protein appears in your body

Although M protein is the hallmark product of monoclonal gammopathies, the detection of M protein in the body does not mean that the patient has monoclonal gammopathies. It may also be monoclonal gammopathies of undetermined significance (MGUS). Regular physical examinations and follow-up are very important for such patients.

**How ​​can this disease be detected? ** The secret is hidden in the ordinary test report

In the general biochemical report, if there is an increase in globulin, an inverted white/globulin ratio, positive urine protein, and abnormal immunoglobulin in the liver function test, it is necessary to highly suspect the presence of M protein and conduct professional testing in time. Don't underestimate the role of these indicators! They are like "super detectives" in the body, and may reveal those secrets hidden in the dark.

Currently, serum protein electrophoresis is mostly used in clinical practice to detect M protein.

3. What are the clinical manifestations of monoclonal immunoglobulin disease?

Common diseases of monoclonal immunoglobulin disease include multiple myeloma, systemic amyloidosis, etc. The clinical symptoms are diverse and may even lead to organ failure and death in severe cases.

1. Multiple myeloma : Multiple myeloma is common in middle-aged and elderly people. It is the second most common tumor of the blood system. Its early symptoms are easily confused with other common geriatric diseases.

2. Systemic amyloidosis : amyloid deposits in the extracellular tissue spaces throughout the body, thus destroying the functions of cells and organs. The clinical manifestations vary due to differences in the deposited amyloid and the affected organs.

According to statistics, about 40% of patients visit the orthopedics department due to bone pain; 20% of patients visit the gastroenterology department due to repeated nausea and vomiting; 20% of patients visit the nephrology department due to proteinuria or renal insufficiency; 10% of patients visit the cardiovascular department due to repeated chest tightness; only some patients with anemia or bleeding tendency will first visit the hematology department.

Monoclonal gammopathy has various symptoms and is easily misdiagnosed . Therefore, early identification of this disease is crucial for subsequent treatment.

In daily life, if the following situations occur, you should be alert and go to the hospital as soon as possible to complete relevant examinations:

1. Unexplained hypercalcemia; 2. Unexplained bone pain or recurrent fractures; 3. Unexplained erythrocyte sedimentation rate greater than 100 mm/h; 4. Unexplained proteinuria and renal impairment; 5. Patients with unexplained elevated globulin in biochemical examinations; 6. Unexplained anemia or the degree of anemia is not parallel to the degree of kidney damage; 7. Unexplained decrease in resistance, repeated infections or severe infections.

Authors: Ying Furong (Department of Laboratory, First Affiliated Hospital of Wenzhou Medical University), Tong Yuheng, Yang Qiuqin, Yan Xiang, Xiao Yue (Wenzhou Medical University)