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** 60 years or older with persistent bone pain, particularly back pain, or unexplained fracture offer investigations including: A full blood count, serum calcium, and plasma viscosity or erythrocyte sedimentation rate (ESR).
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For people aged 60 years or older with hypercalcaemia or leukopenia, and a presentation consistent with possible myeloma offer investigations including:
- Very urgent (within 48 hours) serum electrophoresis, serum-free light-chain assay, and Bence-Jones protein urine assessment.
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For people whose plasma viscosity, ESR, or incidental findings on blood tests and presentation are consistent with possible myeloma consider:
- Very urgent (within 48 hours) serum electrophoresis, serum-free light-chain assay, and Bence-Jones protein urine assessment.
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Also consider the following additional investigations to help confirm the diagnosis of multiple myeloma:
- Peripheral blood film — to look for rouleaux (aggregations of red blood cells), which might suggest underlying paraproteinaemia.
- Serum urea, creatinine, electrolytes, and liver function tests — to detect renal impairment, raised uric acid from increased tumour cell turnover, and to determine total protein concentration, which is usually raised in multiple myeloma.
- X-rays of symptomatic areas for people with bone pain — to rule out pathological fractures.