HCDP Manchester

Plasma cell dyscrasia and amyloid

PATHWAY OPTIONS
There are a number of choices. Please ensure that you select the correct pathway for your sample. Please give as much clinical detail as possible for all samples.

Pathway 14A: Myeloma basic work up (limited tests)

Use this pathway for low risk cases where diagnosis is required but additional information not needed. For example in frail individuals or those where treatment is not immediately planned (evaluation of paraprotein).
The following tests will be performed:

  • Morphology marrow
  • Markers: option myeloma marrow
  • Trephine biopsy [immune-stain if indicated]

Pathway 14B: Myeloma including cytogenetics

Use this pathway in cases where cytogenetics is required to guide treatment.
The following tests will be performed:

  • Morphology marrow
  • Markers: myeloma
  • Trephine biopsy [immune-stain and amyloid]
  • Cytogenetic analysis with cell selection
  • DNA (store): will be activated automatically if plasma cells > 10% for TP53

Pathway 14C: Myeloma assessment including amyloid

Use this pathway for investigation of myeloma where there is concern for additional amyloidosis, or where there may be amyloidosis without overt myeloma.
The following tests will be performed:

  • Morphology marrow
  • Markers: myeloma
  • Trephine biopsy [immune-stain and amyloid]

Pathway 14D: Myeloma including amyloid assessment and cytogenetics

Use this pathway for investigation of myeloma where there is concerned for additional amyloidosis and where additional assessment of cytogenetics is required.
The following tests will be performed:

  • Morphology marrow
  • Markers: myeloma
  • Trephine biopsy (immune-stain and amyloid)
  • Cytogenetic analysis with cell selection (hold)
  • DNA (store): will be activated automatically if plasma cells > 10% for TP53

Pathway 14E: Plasma cell leukaemia (blood)

Use this pathway for investigation of blood plasma cells in cases where plasma cell leukaemia is suspected.
The following tests will be performed:

  • Morphology blood
  • Markers: blood

Pathway 14F: Amyloidosis (specialist centres only)

Use this pathway for full investigation of patients where there is a high index of suspicion of amyloid.
The following tests will be performed:

  • Morphology marrow
  • Markers: myeloma
  • Trephine biopsy [immune-stain and amyloid]
  • Cytogenetic analysis with cell selection (ANALYSE)
  • DNA (store): will be activated automatically if plasma cells > 10% for TP53