Multiple myeloma, a relatively unknown disease to both patients and non-hematologists, is often misdiagnosed and underdiagnosed, with some authors in China reporting a misdiagnosis rate of up to 70%.
The previous view was that multiple myeloma had a low incidence and was a rare hematologic neoplastic disease. Today, due to the aging of our population and environmental pollution, as well as the improvement of diagnostic techniques, the incidence of multiple myeloma is gradually increasing and has become a common hematologic neoplastic disease. We should have the understanding that myeloma is not uncommon and it is all around us! Xiping Dai, Department of Hematology, Guangdong Provincial Hospital of Traditional Chinese Medicine
Due to the wide range of clinical manifestations and the lack of characteristics, especially in the early stage, the disease often manifests only as a certain aspect of symptoms and is seen in different departments, such as unexplained anemia (often seen in internal medicine); or bone pain, bone destruction, fracture (often seen in orthopedics); or chronic nephritis, renal insufficiency (often seen in nephrology); or recurrent lung and urinary tract infections and fever (often seen in respiratory medicine, nephrology); or Cardiac insufficiency (often seen in cardiology); or hypercalcemia, so it is difficult to draw attention to multiple myeloma at an early stage and think of it in time, which is one of the reasons for underdiagnosis.
Secondly, the clinicians’ predominantly symptom-based and programmed diagnostic thinking, lack of comprehensive medical history, physical examination, and necessary laboratory tests, is also one of the reasons why the disease is easily missed. This requires clinicians to be familiar with the clinical manifestations and diagnostic points of multiple myeloma, and to pay attention to comprehensive physical examination and systematic history questioning in order to avoid missed diagnosis as much as possible.
From my own experience, most patients with multiple myeloma are first seen in outpatient clinics or hospitalized in orthopedics, nephrology, or general internal medicine due to bone disease, nephropathy, anemia, etc. They are found to have a combination of various clinical manifestations and are finally diagnosed through blood tests that reveal anemia, elevated hematocrit and globulin, renal insufficiency, hypercalcemia, etc. Further tests such as bone marrow aspiration are performed, and such cases are It is becoming more and more common.
In conclusion, if we can change the concept, raise awareness and pay attention to the necessary laboratory tests, the misdiagnosis rate of multiple myeloma will be greatly reduced!