The Curbsiders Internal Medicine Podcast #247 SPEP It Up: MGUS, Myeloma, and Immunology, Oh My!
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Dec 21, 2020 Dr. Jorge Castillo from Harvard and Dana Farber joins the hosts to discuss topics such as immunology basics, limitations of the SPEP, when to suspect MGUS and myeloma, and how to talk to patients about these conditions. They also touch on Waldenstrom's and amyloidosis, providing valuable clinical insights and diagnostic frameworks. Tune in to learn more about these fascinating topics in internal medicine.
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When to Refer Hematology
- Refer to hematology when M spike is >1.5, or anemia, hypercalcemia, or kidney dysfunction present.
- It's generally safe to refer any patient with an M spike for specialized evaluation.
Optimal Labs Before Referral
- Before referring, order key labs: CBC, metabolic panel, immunoglobulin levels, SPEP, and immunofixation.
- In suspected kidney involvement, add urine protein electrophoresis and quantification, and evaluate for hypercalcemia causes.
Skeletal Survey Importance
- Obtain a baseline skeletal survey including skull, spine, ribs, hips, and long bones to evaluate bone lesions.
- Further specialized imaging such as MRI or PET should be done by hematology if the survey is negative but suspicion remains.