![]() ![]() Similarly, because Igs are measured as part of the serum total protein, the globulin gap (total protein minus albumin) can be elevated above 4 g/dL in patients with a monoclonal gammopathy. A low anion gap can also be due to hypoalbuminemia or laboratory error. There are several “footprints” of the disorder that may be found incidentally: low anion gap, elevated globulin gap or rouleaux formation of red cells on a blood smear.īecause some immunoglobulins (Igs) are cationic, a clone of plasma cells that makes excess cationic immunoglobulin (Ig) can cause a low serum anion gap. Patients typically have abnormalities that are incidentally noted on either routine lab tests or labs ordered for alternate purposes as there is no established role for screening for the disorder. While MGUS is, by definition, an asymptomatic condition, there are often clues that lead to this diagnosis. Since MGUS most often progresses to multiple myeloma, the clinician must rule out symptoms/signs that are attributable to myeloma or related disorders (see below). To make the diagnosis, the clinician must establish two key findings:Ī monoclonal gammopathy seen on serum protein electrophoresis (or serum immunofixation)Ībsence of symptoms related to the monoclonal gammopathy Diagnostic Confirmation: Are you sure your patient has benign monoclonal gammopathy? Second, once the diagnosis of MGUS is established, the clinician needs to consider the risk of progression to a malignant condition to provide the patient with appropriate prognostic information and formulate an appropriate follow-up plan. ![]() a symptomatic patient with MGUS either has symptoms from another disorder or does not have MGUS). First, by ruling out organ involvement or associated symptoms, the clinician can establish the diagnosis (i.e. ![]()
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