Multiple myeloma is a neoplasm of the bone marrow plasma cells. The peak incidence is patients aged 60-70 years.

Features of myeloma: CRABBHAI

C - hyperCalcaemia

R - renal insufficiency

A - anaemia

B - bone pain

B - Bleeding

H - Hyperviscosity - headaches, visual disturbances, thrombosis

A - Amyloidosis - has multiple sequelae including cardiac failure and neuropathies

I - increased susceptibility to infections

• Renal impairment in myeloma has 4 causes: AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis

PC

Patients can be asymptomatic, the diagnosis being suspected by abnormal ‘routine’ blood tests.

• bone disease
  • bone pain
  • osteoporosis + pathological fractures (typically vertebral)
  • osteolytic lesions
• Symptoms of anaemia
• lethargy
• infection