Project CRAB - multiple myeloma

The CRAB project is designed to raise the awareness of primary care physicians of multiple myeloma, diagnostic options and novel approaches in the treatment of this disease, thus giving the patient the opportunity to receive timely and effective therapy.

The story of Mrs. Marcela, 63 years old

Anaemic syndrome, Normocytic, normochromic anemia. Indiscriminate initiation of oral iron therapy!

3 months later, back pain and metrorrhagia
Progression on anaemia – normocytic, normochromic
Gynaecological malignancy ruled out.
Vitamin B12 i.m. added wrongly. Unnecessary referral for GIT endoscopy.

The story of Mr. Štěpán, 45 years old

Leta diabetes mellitus / Renal insufficiency, recurrent sepsis, ESR 90/110

Serum and urinary protein electrophoresis not done!
Repeat diagnosis of diabetic nephropathy.
Development of renal failure, haemodialysis initiated.
Renal failure could have been avoided.

The story of Mrs. Jana, 56 years old

Low back pain / rehabilitation techniques, painkiller injections

X-ray was not performed as were not ESR and protein electrophoresis!
After 4 months development of lower limb paraparesis.
Destruction of vertebrae Th 12-L3 observed.
Haematology-oncology therapy was not initiated until 4 months later resulting in complete remission and return to everyday life.

Multiple myeloma

The symptoms of multiple myeloma are initially most nonspecific, which is why patients with complaints will first contact general practitioners, neurologists, orthopedicians, and rehabilitation specialists. This explains why awareness of primary care physicians of possible presentations and symptoms of multiple myeloma is absolutely critical for the timely diagnosis of this disease.

It is just these physicians who should consider, in the differential diagnosis process, also the possibility of multiple myeloma, perform special investigations and, if confirming the suspicion, refer the patient to a specialist, that is, to an outpatient unit of haematology.

The most common symptoms leading patients with multiple myeloma to a doctor

Pain in the skeleton

Most frequently the vertical skeleton (vertebrogenic algic syndrome, pathological fracture in case the skeleton is affected by myeloma cells)
Anaemia + hyperviscosity syndrome

Fatigue, breathlessness, general feebleness, blurred vision, uncertainty when walking, headache
Incidental laboratory finding!

High sedimentatiopn rate (often up to 100), anaemia (especially normo- or macrocytar), high total protein (often over 100 gpl), hypocalcaemia, isolated elevation of ALP, high urea, creatinine, protein in urine, paraprotein detection.
Recurrent infections

Especially respiratory ones
Signs of renal insufficiency

Edems, urinal disorders

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