From the Guidelines
Physical examination of multiple myeloma should include a thorough evaluation of the patient's overall condition, with a focus on detecting signs and symptoms related to the disease, particularly those related to the CRAB criteria [hypercalcaemia, renal insufficiency, anaemia or bone lesions] 1.
Key Findings on Physical Examination
- Checking for pallor, which may indicate anemia
- Evaluating for bone tenderness, particularly in the back, ribs, and skull
- Assessing for signs of hypercalcemia, such as confusion, weakness, and abdominal pain
- Examining for lymphadenopathy and hepatosplenomegaly
- Checking for signs of infection, such as fever and tachycardia
- Evaluating for neurological symptoms, such as numbness, weakness, and bowel or bladder dysfunction, which may indicate spinal cord compression
- Assessing for signs of renal impairment, such as edema and decreased urine output
Additionally, a thorough musculoskeletal examination should be performed to assess for bone lesions and fractures.
It is also essential to monitor the patient's vital signs, including blood pressure, pulse, and oxygen saturation, and to perform a thorough neurological examination to assess for any neurological deficits, as recommended by the NCCN guidelines 1.
The physical examination should be performed regularly to monitor the patient's response to treatment and to detect any potential complications early, taking into account the patient's overall condition and the presence of any high-risk chromosomal aberrations 1.
From the Research
Physical Examination Findings
The key findings on physical examination of a patient with multiple myeloma (Plasma Cell Myeloma) include:
- Bone pain, particularly in the back and ribs, due to lytic lesions and osteoporosis 2, 3
- Signs of anemia, such as pallor and fatigue, which occur in approximately 73% of patients 4
- Renal impairment, which can manifest as decreased urine output, edema, and hypertension 4, 2
- Hypercalcemia, which can cause symptoms such as nausea, vomiting, and altered mental status 4, 2
- Neurological symptoms, such as spinal cord compression, which can cause back pain, weakness, and sensory deficits 2, 3
Laboratory and Imaging Findings
In addition to physical examination findings, laboratory and imaging tests are crucial in diagnosing and monitoring multiple myeloma. These include:
- Serum protein electrophoresis and immunofixation to detect monoclonal paraprotein 4, 2
- Urine protein electrophoresis to detect Bence-Jones proteins 4, 2
- Complete blood count to evaluate anemia and other cytopenias 4, 2
- Blood chemistry tests to assess renal function and electrolyte levels 4, 2
- Skeletal radiographs and other imaging modalities, such as computed tomography, positron emission tomography, and magnetic resonance imaging, to evaluate bone lesions and other complications 4, 2, 3
Clinical Presentation
Multiple myeloma can present with a wide range of symptoms, including:
- Bone pain and pathologic fractures 2, 3
- Fatigue and weakness due to anemia 4, 2
- Renal impairment and kidney failure 4, 2
- Hypercalcemia and its associated symptoms 4, 2
- Infections and other complications due to immunosuppression 2, 3
- Neurological symptoms, such as spinal cord compression and neuropathy 2, 3