Morawska Marta, Dwilewicz-Trojaczek Jadwiga, Stompór Tomasz, Ligocki Piotr, Stopiński Marek, Sutkowski Michał, Grząśko Norbert, Kordecka Anna, Kordecki Mariusz, Jurczyszyn Artur, Dytfeld Dominik, Wróbel Tomasz, Jamroziak Krzysztof, Druzd-Sitek Agnieszka, Walter-Croneck Adam, Giannopoulos Krzysztof
Experimental Hematooncology Department, Medical University of Lublin & Hematology Department, St. John's Cancer Center, 20-093 Lublin, Poland.
Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2023 Feb 8;12(4):1345. doi: 10.3390/jcm12041345.
Monoclonal gammopathies and multiple myeloma should be screened in the primary care setting.
The screening strategy consisted of an initial interview supported with the analysis of basic laboratory test results and the increasing laboratory workload in the following steps was developed based on characteristics of patients with multiple myeloma.
The developed 3-step screening protocol includes evaluation of myeloma-related bone disease, two renal function markers, and three hematologic markers. In the second step, the erythrocyte sedimentation rate (ESR) and the level of C-reactive protein (CRP) were cross-tabulated to identify persons qualifying for confirmation of the presence of monoclonal component. Patients with diagnosed monoclonal gammopathy should be referred to a specialized center to confirm the diagnosis. The screening protocol testing identified 900 patients with increased ESR and normal level of CRP and 94 of them (10.4%) had positive immunofixation.
The proposed screening strategy resulted in an efficient diagnosis of monoclonal gammopathy. The stepwise approach rationalized the diagnostic workload and cost of screening. The protocol would support primary care physicians, standardizing the knowledge about the clinical manifestation of multiple myeloma and the method of evaluation of symptoms and diagnostic test results.
在初级保健机构中应筛查单克隆丙种球蛋白病和多发性骨髓瘤。
筛查策略包括初始访谈，并辅以基本实验室检查结果分析，后续步骤中增加的实验室工作量是根据多发性骨髓瘤患者的特征制定的。
制定的三步筛查方案包括评估骨髓瘤相关骨病、两项肾功能标志物和三项血液学标志物。在第二步中，对红细胞沉降率（ESR）和C反应蛋白（CRP）水平进行交叉制表，以确定符合条件需确认是否存在单克隆成分的人员。已诊断为单克隆丙种球蛋白病的患者应转诊至专科中心以确诊。筛查方案检测出900例ESR升高且CRP水平正常的患者，其中94例（10.4%）免疫固定电泳呈阳性。
所提出的筛查策略实现了单克隆丙种球蛋白病的高效诊断。逐步方法使诊断工作量和筛查成本合理化。该方案将支持初级保健医生，规范关于多发性骨髓瘤临床表现以及症状评估和诊断检查结果方法的知识。
