Haematological diseases associated with paraproteins

1) Monoclonal gammopathy of uncertain significance (MGUS).

3% of over-70s and 5% of over the age of 80s have paraproteins which are frequently found incidentally and not associated with symptoms or physical findings.
The overall risk of MGUS progression to myeloma is around 1% per year – this remains constant over time.

2) Myeloma.

3) Low grade Non-Hodgkin Lymphoma can have IgM or IgG paraproteins.

4) Rarely seen with CLL and amyloidosis.

Who to refer to haematology urgently:

Any new paraprotein or SFLC ratio >100 with accompanying features suggestive of multiple myeloma or other haematological malignancy:

• hypercalcaemia • unexplained renal impairment
• urinary BJP • bone pain or pathological fracture
• radiological lesions reported as suggestive of myeloma
• unexplained anaemia or other cytopenia
• hyperviscosity symptoms (headache, visual loss, acute thrombosis)

Patients with suspected spinal cord compression should be referred in line with the MSSC pathway; if myeloma is suspected discussion with the on call Haematologist by GP or receiving clinician urgently is helpful.

Any patient with a paraprotein not meeting with the above criteria can be discussed with haematology via Advice and guidance. Patients may not need a referral.

Who not to refer to haematology:

Patients with raised immunoglobulin levels in the absence of a monoclonal paraprotein band on serum electrophoresis.

Polyclonal gammopathy implies a non-specific immune reaction and is not associated with underlying haematological disorders