Clinical features and presentation

• Spectrum from asymptomatic paraproteinaemia detected on routine testing (~20%) to rapidly progressive illness with extensive, destructive bony disease.

• Most present with bone (usually back) pain (~75%) or pathological fracture; kyphosis and loss of height may occur from vertebral compression fractures.

• Weakness and fatigue (>50%), recurrent infection (10%) and thirst, polyuria, nocturia or oedema due to renal impairment (~10%) also common.

• Acute hypercalcaemia, symptomatic hyperviscosity (mental slowing, visual upset, purpura, haemorrhage), neuropathy, spinal cord compression, amyloidosis and coagulopathy less frequent at presentation.

Electrophoresis: from L —► R, urine BJP, serum M band (myeloma); polyclonal Igs; normal.

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