Multiple Myeloma - emergency medicine perspective
Multiple myeloma is a clonal plasma‑cell malignancy producing monoclonal immunoglobulin (M‑protein) or free light chains and causing bone destruction, marrow failure and end‑organ damage. It most commonly affects older adults (median age >60).
Emergency clinicians must recognise acute presentations, initiate stabilising care, order appropriate investigations, and identify time‑critical complications that need urgent specialist input (haematology, nephrology, spinal/orthopaedics, radiology/neurosurgery) (NICE NG35; NG12; NG234).
Pathophysiology (relevance to ED) Multiple myeloma causes disease and complications important to emergency care by:
- Producing excess monoclonal immunoglobulin and free light chains (κ or λ), which can increase plasma viscosity and injure renal tubules (cast nephropathy).
- Promoting osteolysis (lytic lesions) with bone pain, pathological fractures and hypercalcaemia.
- Infiltrating bone marrow causing anaemia, thrombocytopenia and neutropenia with attendant bleeding and infection risk.
- Depositing amyloid in tissues leading to peripheral and autonomic neuropathy in some patients.
Presentation - when to suspect myeloma Consider multiple myeloma in older patients, particularly those >60 years, who present with:
- Unexplained normocytic anaemia.
- New, localised or progressive bone pain (especially spine or ribs).
- Acute or progressive renal impairment without a clear alternative cause.
- Hypercalcaemia (confusion, polyuria, constipation, arrhythmia).
- Recurrent or severe infections (pneumonia, urinary tract infection).