🧪 FREE MSRA PODCAST – MGUS Made Simple: Monitoring, MProteins & Myeloma Risk 🎧
MGUSmight sound like a rare and intimidating term, but it's surprisingly common –especially in older adults. In this episode, we break it down clearly andconcisely for your MSRA prep. You'll learn what MGUS is, how it differs frommultiple myeloma, what tests you need, and why long-term monitoring is key. 🔍🧠
🧠Key Learning Points
📌Definition
MGUS = Monoclonal Gammopathy of Undetermined Significance.
It's a benign plasma cell disorder marked by thepresence of a monoclonal protein (M proteinor paraprotein) in the blood, without symptoms or organ damage.
📌Pathophysiology
• Caused by clonal proliferation of plasma cells
• Produces a singletype of immunoglobulin (IgG, IgA or light chains)
• Think of it as thestart of a spectrum:
MGUS → SmoulderingMyeloma → Multiple Myeloma
• Doesn’t affectorgan systems directly but carries a risk ofprogression
📌Diagnostic Criteria
✔M protein <30 g/L
✔<10% plasma cells in bone marrow
✔No CRAB features (hyperCalcaemia, Renal dysfunction, Anaemia, Bonelesions)
✔No symptoms (or minimal, such as peripheral neuropathy in rarecases)
📌Common PresentingClue
• Often asymptomatic – found incidentally on routinebloods
• May beinvestigated due to red flags (e.g.unexplained anaemia, bone pain, fatigue, high ESR)
📌Risk Factors
🔹 Age >50 (↑ prevalence with age)
🔹 Male sex
🔹 Family history of MGUS or myeloma
🔹 Genetic abnormalities (e.g. trisomies)
🔹 Possible environmental exposure (pesticides,radiation)
📌DifferentialDiagnosis
Before confirmingMGUS, rule out:
– Multiple Myeloma
– Waldenström Macroglobulinaemia
– Amyloidosis
– CLL and lymphomas
– Chronic infection or inflammation
📌Key Investigations
🧪SPEP – detects M protein spike
🧪Immunofixation (IFE) – confirms type (e.g. IgG kappa)
🧪Serum Free LightChains – checks kappa/lambda ratio
🧪Urine Bence-Jonesprotein – essential for light chaindetection
🧪Bone Marrow Biopsy – if protein level is borderline or symptoms arise
🖼️Imaging(X-ray/CT/MRI) – to rule out bonelesions
🧠Mnemonic for investigations:
S-I-F-U-B-M = SPEP, IFE, Free light chains,Urine, Bone marrow, Imaging
📌Monitoring &Management
• No treatment required unless progression
• Regular follow-up with:
– M protein levels
– FBC, renalfunction, calcium
– Clinical reviewfor symptoms
• Monitoringinterval: Every 6–12 months, lifelong
• Watch for signs ofmyeloma: back pain, anaemia, hypercalcaemia, infections
📌Prognosis &Complications
• Generallyexcellent for MGUS itself
• ~1% annual risk of progression to multiplemyeloma or related disorders
• ~10% progresswithin 10 years
• Risk persistslifelong → lifelong monitoring essential
• Neuropathy maydevelop in 10–30% (sensory > motor)
📎More MSRA Resourcesfor MGUS
📝 Revision Notes:
🧠 Flashcards:
💬 Accordion Q&A Notes:
🚀 Rapid Quiz:
🎓 Haematology Course:
https://www.passthemsra.com/courses/haematology-for-the-msra/
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