Diagnostic delay in plasma cell dyscrasias

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Atkin, Catherine Emma (2019). Diagnostic delay in plasma cell dyscrasias. University of Birmingham. M.D.

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Abstract

Background:
Multiple myeloma is associated with significant diagnostic delay, and early mortality, particularly after emergency presentation. Given the varied symptoms of myeloma, symptom-based strategies to improve diagnosis may be ineffective - alternative strategies are needed.

Methods:
1) Symptoms and diagnostic pathway were assessed in patients with myeloma. Analysis considered those with and without prior knowledge of monoclonal gammopathy of undetermined significance (MGUS).
2) Blood test results prior to diagnosis were assessed in a cohort of myeloma patients.
3) Patients presenting acutely to hospital with medical complaints were recruited to assess the prevalence of detectable paraproteinemia.

Results:
1) Those diagnosed via acute services had more end organ damage and more advanced disease without a longer diagnostic pathway, suggesting faster disease progression. Prior knowledge of MGUS was associated with less end organ damage.
2) Change in blood test results was demonstrated in the two years before diagnosis
3) There was a higher prevalence of paraproteinemia in acute hospital admissions compared to expected population rates (5.3% vs 3.2%)

Discussion:
Multiple factors affect the diagnostic pathway, including aggressiveness of disease. Feasible strategies to improve diagnosis could be developed, including automated processes to test based on routine blood test results, and identification of MGUS, for instance in acute medical admissions.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):