Indications for testing for monoclonal gammopathy
| Symptoms and signs Peripheral neuropathy (demyelinating or axonal) with or without autonomic features Pathologic fractures Raynaud phenomenon, acrocyanosis (suggestive of cryoglobulinemia) Hyperviscosity symptoms (headaches, blurry vision, lightheadedness, shortness of breath) in the presence of an immunogloblin M monoclonal protein Heart failure symptoms of unclear etiology with findings on ultrasonography suggestive of cardiac amyloidosis Unexplained peripheral edema: a key caveat is nephrotic syndrome, in which testing for light-chain amyloidosis should be considered |
| Laboratory and imaging findings Normocytic anemia of unclear etiology High erythrocyte sedimentation rate Elevated serum viscosity Elevated total serum protein Nephrotic-range proteinuria Unexplained renal failure Elevated calcium level Osteolytic lesions on imaging Recurrent infections (mostly sinopulmonary) Hypo- or hypergammaglobulinemia |