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Independents' Day

GPs 'should use simple blood tests' to improve early diagnosis of multiple myeloma

GPs should use simple blood tests to support symptoms when diagnosing patients with multiple myeloma, in order to improve early detection rates, researchers have said.

The research team from the University of Exeter and University of Oxford analysed symptom prevalence and blood tests in 2,700 myeloma patients, and found that plasma viscosity and erythrocyte sedimentation rate are the best markers to support symptoms.

They said that using simple blood tests in patients with back pain, rib pain, chest pain, and recurrent chest infections could see patients diagnosed faster.

The researchers aimed to identify which blood tests are useful in determining a diagnosis of myeloma, a cancer characterised by numerous non-specific symptoms which results in diagnostic delays.

The matched case-control study, set in UK primary care, used routinely collected data from the Clinical Practice Research Datalink to analyse symptom prevalence and blood tests up to five years before diagnosis in 2,703 cases and 12,157 matched controls.

The paper, published in the BJGP, found that in the year before diagnosis 85% of patients with myeloma had an abnormal erythrocyte sedimentation rate (ESR) compared with 46% of controls, 81% had an abnormal plasma viscosity (PV) compared with 41% of controls, and 46% had an abnormal C-reactive protein (CRP) compared with 37% of controls.

They also reported that back pain, rib pain, chest infections, chest pain, and nosebleed, became more common in patients with myeloma compared with controls at around two years before diagnosis.

And symptoms suggesting advanced disease such as fractures, weight loss, and nausea, were more common up to one year before diagnosis, especially within the last three months.

Researchers said: ‘The results of this study suggest that the best inflammatory markers to supplement symptoms of myeloma are plasma viscosity and erythrocyte sedimentation rate, while C-reactive protein is unhelpful.

‘In addition, the combination of a normal haemoglobin and plasma viscosity can be used to rule out the disease on patients currently being tested in primary care.'

The team added: ‘Myeloma diagnosis could potentially be expedited by the use of simple blood tests in patients with back pain, rib pain, chest pain, and recurrent chest infections, which have been identified as early presentations of myeloma.’

MPs called for GPs to order more blood test earlier this year, arguing that to speed up diagnosis GPs should instigate blood cancer investigations for all patients who display one or more symptom.

Readers' comments (6)

  • Grandmothers to undergo mandatory training to suck eggs! Yet more stating the bloody obvious from the mob in Exeter, every week there seems to be some facile ‘GP should’ from this outfit.

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  • Good to know that elevated ESR in chest infections must be myeloma! LOL

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  • The BJGP that bastion of academic excellence and sound research .Couldnt light the wood-burner with the paper so among other thing another reason to stop my membership.

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  • Actually I think that this research offers pretty good advice.

    Every year in general practice lowered my threshold for doing inflammatory markers + Alk Phos (and PSA in men) in individuals with musculo-skeletal symptoms - especially "mechanical back pain".

    It isn't just myeloma - I've seen back ache due to TB (twice}, staph abscess (three times) and multiple cases of malignancy. Positive blood tests - as always, but not invariably - are more likely in the rare visitor.

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  • Of course it’s sucking eggs as usual. Mind you AI, which is just around the corner, will automatically get patients referred. In fact, probably true AI is not needed, it is just about getting good algorithms.

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  • Jones the Tie

    ooh great non specific inflammatory markers mean myeloma only...FFS how about the Ivory Tower Bullshitters get out into the real world and try and manage clinical risk in short appointments about 3 problems ... utter shite...

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