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Multiple Myeloma Workup — RACP Adult Medicine MCQ

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ModerateHaematologyMultiple Myeloma WorkupRACP Adult Medicine

A 65-year-old woman presents with bone pain, fatigue, and a serum protein electrophoresis showing a monoclonal band in the gamma region. Urine Bence Jones protein is positive (free kappa light chains). Bone marrow shows 25% plasma cells. Skeletal survey shows multiple lytic lesions in the skull. Serum free light chain ratio is markedly abnormal. Calcium 2.95 mmol/L, creatinine 180 μmol/L, Hb 92 g/L. What is the most appropriate initial investigation to confirm the paraprotein type?

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Correct answer: C — Serum immunofixation

While SPEP identifies the monoclonal band, serum immunofixation electrophoresis (IFE) is required to characterise the heavy chain type (IgG, IgA, IgM, IgD, IgE) and light chain type (kappa or lambda). This is essential for diagnosis and monitoring. All patients with a monoclonal band should have IFE performed to confirm and type the paraprotein.

Reference: IMWG – 2024 – Myeloma Diagnostic Workup; ALLG/MSAG