The Core IM 5 Pearls Podcast episode focuses on monoclonal gammopathies, covering their clinical presentation, initial workup, urine testing, the spectrum of these gammopathies, and monoclonal gammopathy of clinical significance (MGCS). Speakers Dr. Shreya Trivedi and Dr. Nate Long, along with insights from hematology oncologist Dr. Aaron Goodman and Dr. Vincent Rajkumar, discuss the prevalence of plasma cell disorders, common illness scripts, and the CRAB mnemonic (hypercalcemia, renal dysfunction, anemia, and bone lesions). They explain the differences between SPEP, immunofixation, and serum-free light chain assays, emphasizing the importance of appropriate testing and interpretation in the context of renal function and inflammation. The podcast further differentiates between MGUS, smoldering myeloma, and multiple myeloma, offering guidance on patient counseling and management, including when to consult hematology and perform bone marrow biopsies. The speakers also highlight MGCS, where the secreted immunoglobulin causes organ damage, and discuss the importance of considering MGCS in patients with unexplained symptoms, especially those affecting the kidneys, skin, or nerves.
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