Myelomarelated organ or tissue impairment endorgan damage

• Elevated calcium levels: serum calcium >0.25mmol/L above upper limit of normal or corrected serum calcium >2.75mmol/L or >11mg/dL.

• Renal insufficiency: (creatinine >173|_imol/L or >2mg/dL).

• Anaemia: Hb 2g/dL below normal range or Hb <10g/dL.

• Bone lesions: lytic lesions or osteoporosis with compression fractures recognised by conventional radiology.

• Others: symptoms of hyperviscosity; amyloidosis; recurrent bacterial

Bone marrow aspirate in myeloma showing numerous plasma cells (note binucleate cell, centre left).

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