Doctors sometimes find myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an X-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.
In short, diagnostic testing will tell you whether you have myeloma and what stage your disease is in.
Some prognostic tests can even characterize the genetic abnormalities of the cancerous plasma cell. Prognostic tests help you and your doctor determine the best course of treatment.
Whether diagnostic or prognostic, lab tests for myeloma involve testing the blood, urine and bone. How frequently you will undergo testing will depend upon:
When undergoing treatment, some people may undergo prognostic testing monthly or even weekly; at other periods you may not require testing for much longer periods of time. There is no one “schedule” for testing – everyone’s condition must be assessed individually.
Diagnostic Testing
Prognostic Testing
Objective
To determine whether you have myeloma
To stage your disease, determine how aggressive it is and see whether it is responding to treatment
When Performed
When being diagnosed
Whenever required, depending upon your individual condition and treatments
Types of Tests
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A Complete Blood Count (CBC) measures the number of white and red blood cells in your blood as well as the number of platelets. When studying the results of a CBC, your doctor will look for:
Although values can vary, normal CBC results are summarized in the following chart. Values that are significantly outside of the normal range will raise questions and may lead to other tests.
Count
Definition
Normal Range*
(Canadian values)
(American values)
Erythrocytes (RBCs)
Erythrocytes are also known as red blood cells, erythrocytes, or red corpuscles. Erythrocytes transport oxygen and carbon dioxide between the lungs and all the tissues of the body. A circulating erythrocyte is little more than a container for hemoglobin. Low numbers of red blood cells or low hemoglobin or hematocrit indicate anemia, which can cause physical and mental fatigue
F : 4,1 - 5,1 x 1012/L M : 4,5 - 5,3 x 1012/L
Hemoglobin (Hb)
The iron-containing oxygen-transport substance in the red blood cells
F : 120 - 160 g/L H : 130 - 180 g/L
F : 12 - 16 g/dL H : 13 - 18 g/dL
Hematocrit (HCT)
Measures of the proportion of blood volume that is occupied by red blood cells
F : 36 - 46% M : 37 - 49%
Leukocytes (WBCs)
White blood cells or leukocytes are cells of the immune system which defend the body against both infectious disease and foreign materials. A low number of white cells can increase the possibility of infection.
Neutrophils deal with defense against bacterial infection and other very small inflammatory processes and are usually first responders to bacterial infection.
Lymphocytes are responsible for immune responses. There are two main types of lymphocytes: B cells and T cells.
Monocytes are large white blood cell that ingests microbes or other cells and foreign particles.
Basophils are involved in immediate hypersensitivity reactions, such as allergic reactions to wasp stings, and are also involved in some delayed hypersensitivity reactions.
Eosinophils are responsible for combating infection by parasites; they also control mechanisms associated with allergy and asthma.
Total WBC: 3.5 - 10.5 x 109/L
Neutrophils: 1.7 - 7.0 Lymphocytes: 0.9 - 2.9 Monocytes: 0.3 - 0.9 Basophils: 0.0 - 0.3 Eosinophils: 0.05 - 0.5
Platelets
Platelets (or thrombocytes) are involved in the formation of blood clots. Low levels of platelets predispose to bleeding, while high levels may increase the risk of thrombosis.
150 - 450 x 109/L
*Please note that normal values may vary from lab to lab. The ranges are for reference only.
Once the diagnosis of myeloma is made, even more specialized blood tests may be ordered to confirm the diagnosis and determine what type of myeloma you have.
When myeloma is suspected, urine tests may be ordered. Urine tests can be used to:
A 24-hour urine test may be conducted to measure the amount of protein in the urine over a day. Urine protein electrophoresis (UPE) may be conducted to look for free light chains in the urine and to assess kidney function. If they are present, your doctor may follow up with urine immunofixation or blood tests. These tests can help to determine what stage of the disease you are in or how the disease is responding to treatment.
X-rays can be used to check for changes in the bone structure and to determine if there are osteolytic or lytic lesions in the bone (weak spots). A bone (skeletal) survey consists of a series of X-rays of the skull, spine, arms, ribs, pelvis and legs. Less frequently, other imaging techniques may also be used, such as Magnetic Resonance Imaging (MRI), Computerized Axial Tomography (CAT or CT-scan) or Positron Emission Tomography (PET scan).
Samples of the bone marrow may also be taken to check the number of plasma cells. There are two bone marrow sampling techniques. In both cases, samples are usually taken from either the hip or breast bone (aspiration only).
Bone marrow aspiration – a needle with a syringe attached is used to draw a sample of liquid bone marrow. As well as examining the sample under a microscope, the genetics (cytogenetics) of the plasma cells can be studied. Bone marrow biopsy – a biopsy needle is inserted into the bone and rotated to force a tiny sample of solid bone tissue into the needle. A biopsy is usually performed when you are first diagnosed and may not need to be repeated.
Bone marrow aspiration – a needle with a syringe attached is used to draw a sample of liquid bone marrow. As well as examining the sample under a microscope, the genetics (cytogenetics) of the plasma cells can be studied.
Bone marrow biopsy – a biopsy needle is inserted into the bone and rotated to force a tiny sample of solid bone tissue into the needle. A biopsy is usually performed when you are first diagnosed and may not need to be repeated.
Cytogenetics is the study of the structure of chromosomes (the ribbons of DNA that make up our genes). The two techniques most commonly used in the cytogenetics of myeloma are karyotyping and Fluorescence In Situ Hybridization (FISH).
Karyotyping – a means of looking at the chromosomes of an individual cell arranged in pairs and sorted by size. This sort of testing can detect large genetic changes, such as the existence of an extra chromosome. FISH – a powerful molecular technique that uses a fluorescent-labeled probe to determine the presence or absence of a particular segment of DNA. It can detect even small changes, such as the translocation or rearrangement of chromosome segments. return to top
Karyotyping – a means of looking at the chromosomes of an individual cell arranged in pairs and sorted by size. This sort of testing can detect large genetic changes, such as the existence of an extra chromosome.
FISH – a powerful molecular technique that uses a fluorescent-labeled probe to determine the presence or absence of a particular segment of DNA. It can detect even small changes, such as the translocation or rearrangement of chromosome segments.
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