A 63 year old man presented with back pain since few weeks. Blood investigation shows anemia, hypercalcemia and hypoalbuminemia. Serum protein electrophoresis (PEP) demonstrates an M spike. All of the following are MINOR criteria for diagnosis of multiple myeloma, EXCEPT:
Criteria for Diagnosis of Myeloma: Major criteria: Plasmacytomas on tissue biopsy Marrow plasmacytosis >30% plasma cells Monoclonal globulin spike on serum electrophoresis >3.5 gm/dL for immunoglobulin (Ig) G or >2.0 gm/dL for IgA; 1.0 gm/ 24 hrs of kappa or lambda light-chain excretion on urine electrophoresis in the absence of amyloidosis. Minor criteria: Marrow plasmacytosis 10-30% Monoclonal globulin spike present, but less than the levels defined above Lytic bone lesions Normal IgM The diagnosis of plasma cell myeloma is confirmed when at least one major and one minor criterion or at least three minor criteria are documented in symptomatic patients with progressive disease. The presence of features which suppos the diagnosis are anemia, hypercalcemia, azotemia, bone demineralization, or hypoalbuminemia. Ref: van Rhee F., Anaissie E., Angtuaco E., Bael T., Epstein J., Nair B., Shaughnessy J., Yaccoby S., Barlogie B. (2010). Chapter 109. Myeloma. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds),Williams Hematology, 8e.
Bone marrow plasmacytosis = 20%
Multiple lytic lesions on skull X-ray
Plasmacytoma on tissue biopsy
Monoclonal spike < 3.5g/dL for IgG and < 2g/dL for IgA