Plasma Cell Dyscrasias Testing Algorithm

Plasma cell dyscrasias are diseases of the hematologic system, the most common of which is multiple myeloma. Multiple myeloma can evolve from a premalignant monoclonal gammopathy, which is characterized by low levels of monoclonal protein (M protein), low bone marrow involvement, and the absence of end-organ damage. Once a certain monoclonal protein threshold is reached, the disease is defined as smoldering myeloma, and once end-organ damage appears, the gammopathy has progressed to symptomatic myeloma. An initial workup for plasma cell dyscrasias includes an investigation of the presence and type of monoclonal proteins, serum free light chain quantification, and bone marrow evaluation.