The patient is generally fit and well, with no bone pain, B symptoms or neuropathic symptoms. He has had diarrhoea intermittently for a number of years, interspersed with bloating and constipation. The gastroenterologists felt the history was of classical Irritable Bowel Syndrome and had not proceeded to endoscopy or biopsy. Examination of the patient was unrevealing.
The patient has a number of tests requested in the haematology clinic. These included an FBC and film, renal function, urinary protein quantification, estimation of BJP, serum free light chains, repeat serum electrophoresis, serum calcium and coagulation screen. Except for confirmation of the serum paraprotein these tests were normal. The haematologist that saw the patient did not organise a skeletal survey, echo or marrow (some of the suggestions from the discussion so far).
One contributor stated that ‘in real life he is young so would need counselling and follow-up’ which I am sure we would all agree with. Please consider:
- Is age a proven variable for risk of progression of MGUS to Myeloma? How does the risk of progression vary over time?
- How do you counsel a young man with a paraprotein? Have you any top communication skills tips to help explain this diagnosis?
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