Table 7 Multiple myeloma diagnostic tests and their average prices in the private sector
From: Are African primary physicians suspicious enough? Challenges of multiple myeloma diagnosis in Africa
Test name | Reason for test | Result in multiple myeloma | Avg cost (USD) |
|---|---|---|---|
Bone marrow biopsy | 1. Examine the appearance, size, shape and arrangement of the cells 2. Determine presence of myeloma cells and their number. | Confirm myeloma cells | 40.3 |
Bone marrow aspirate for the following: 1. Immunohistochemistry 2. Flow cytometry 3. Cytogenetics 4. Fluorescent in situ hybridization (FISH) | a. Immunohistochemistry helps to identify myeloma cells b. Flow cytometry determines if cells are abnormal and if they are myeloma, lymphoma, other cancers or non-cancerous. c. Cytogenetics determines abnormality in chromosomes d. FISH determines chromosomal changes and changes too small to be seen by cytogenetic testing. | Confirm myeloma cells and chromosomal abnormalities | 419 |
Complete blood count (CBC) | Determines cell count especially RBC count for anemia. | Anemia | 12.2 |
Blood chemistry tests 1. Serum creatinine 2. Serum albumin 3. Calcium 4. Lactic dehydrogenase (LDH) | 1. Creatinine to show how well the kidneys are working 2. Albumin is found in blood 3. Calcium levels determines stage 4. LDH indicates prognosis | High Low High in advanced myeloma High in advanced myeloma | 6.7 8.6 8.6 8.6 |
24-h urine test 1. Urine electrophoresis 2. Urine immunofixation | Determine Bence Jones protein, and monoclonal antibodies in urine | Present and high concentration | 28.5 28.5 |
Quantitative immunoglobulins | Determine changes in the levels of IgA, IgD, IgE, IgG, and IgM proteins | High levels of one type while others remain low. | 111 |
Serum protein electrophoresis (SPEP) | Measures the antibodies in blood and can find a monoclonal antibody | M spike | 26.7 |
Serum-free light chains | Used in in rare cases of myeloma where no M protein is found by SPEP. Since SPEP measures levels of intact (whole) antibodies, it cannot measure the amount of light chains only. | Increased Kappa: lambda ratio (normal is 1: 1) | 78.8 |
Beta-2 microglobulin | An indicator of prognosis | High in advanced myeloma | 28 |
Imaging tests | |||
 Bone X-ray | Detects destruction caused by myeloma cells | Bone destruction | 15 |
 CT scan | Detects bone destruction and guides biopsy | Bone destruction | 90 |
 Magnetic resonance imaging (MRI) | Detailed images can find plasmacytomas not seen on regular X-rays | - | 200 |
 Positron emission tomography (PET) scan | Looks for other plasmacytomas in a patient appearing to have a single plasmacytoma. | - | 150 |