Uncommon Presentations of Plasma Cell Dyscrasias

Renal, GI, and Peripheral Nerves: Evidence-Based Recommendations for the Management of Symptoms and Care for Patients With Multiple Myeloma

“…A diagnostic algorithm developed by Gertz (2016) underscores the importance of positive serum and urine immunofixation results and serum free light chain levels. A biopsy of the target organ (e.g., kidney, heart) is required if immunofixation electrophoresis of the serum or urine reveals monoclonal immunoglobulin light chains and if the clinical suspicion for amyloidosis is high (Brayer, Hussein, & Baz, 2017;Gertz, 2016). Tissue from kidney, bone marrow, or subcutaneous fat requires Congo red staining, which produces an apple-green birefringence when viewed under polarized light (Picken, 2015).…”

“…The most accurate diagnosis of the presence and type of amyloidosis is obtained by mass spectroscopy. If this is not available, immunohistochemical staining is useful (Brayer et al, 2017). Determining the type of amyloid deposition patients have is essential because the selection of therapy depends on an accurate diagnosis (Picken, 2015).…”