Referral for Suspected Plasma Cell Dyscrasia
A patient with suspected plasma cell dyscrasia should be referred to a hematologist for comprehensive evaluation, bone marrow biopsy, and treatment planning. 1
Primary Referral Pathway
Hematology consultation is mandatory for all patients with suspected plasma cell dyscrasia to establish the diagnosis, perform bone marrow evaluation, and guide treatment decisions. 1
The hematologist will coordinate bone marrow aspiration and biopsy to quantify plasma cell percentage, perform flow cytometry immunophenotyping, and conduct cytogenetic evaluation including the myeloma FISH panel—all essential for diagnosis and treatment planning. 1
Ancillary studies directed by the hematologist include detection of minimal residual disease and genetic evaluation of clones, which are critical for identifying small clones and deriving treatment recommendations. 1
Additional Specialist Involvement Based on Presentation
Nephrology Referral
Refer to nephrology when renal involvement is suspected, particularly if there is unexplained kidney dysfunction, proteinuria, or findings suggesting monoclonal gammopathy of renal significance (MGRS). 1
Kidney biopsy may be required to demonstrate monotypic immunoglobulin deposits or infer their involvement in C3 glomerulonephritis or thrombotic microangiopathy with circulating monoclonal immunoglobulin. 1
The finding of immunoglobulin subclass or light chain restriction by immunofluorescence warrants coordinated workup between nephrology and hematology for paraprotein detection and B-cell clone identification. 1
Radiation Oncology Referral
Refer to radiation oncology for patients with solitary plasmacytoma (either solitary bone plasmacytoma or extramedullary plasmacytoma) after imaging excludes additional lesions. 1
High-dose radiation therapy is the definitive treatment for localized disease, achieving 97% 4-year overall survival in solitary presentations. 2
Critical Diagnostic Coordination
The hematologist will order serum protein electrophoresis, immunofixation, and serum free light chain assay to identify and quantify the monoclonal protein, though 1-2% of cases are nonsecretory. 3
Imaging studies (whole-body CT with or without PET, or whole-body MRI) should be performed to look for bone disease, localized plasmacytoma, or lymphadenopathy before finalizing treatment plans. 1
Common Pitfall to Avoid
Do not delay hematology referral while pursuing extensive workup—the bone marrow evaluation and specialized testing required for diagnosis can only be appropriately interpreted and acted upon by a hematologist with expertise in plasma cell disorders. 1
Peripheral blood flow cytometry alone may suffice for diagnosis in patients with chronic lymphocytic leukemia clones, but most plasma cell dyscrasias require bone marrow evaluation that should be coordinated by hematology. 1