TY - JOUR T1 - Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - e586 LP - e593 DO - 10.3399/bjgp18X698357 VL - 68 IS - 674 AU - Constantinos Koshiaris AU - Ann Van den Bruel AU - Jason L Oke AU - Brian D Nicholson AU - Elizabeth Shephard AU - Mick Braddick AU - William Hamilton Y1 - 2018/09/01 UR - http://bjgp.org/content/68/674/e586.abstract N2 - Background Multiple myeloma is a haematological cancer characterised by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients.Aim To identify which blood tests are useful in suggesting or excluding a diagnosis of myeloma.Design and setting A matched case–control study set in UK primary care using routinely collected data from the Clinical Practice Research Datalink.Method Symptom prevalence and blood tests were analysed up to 5 years before diagnosis in 2703 cases and 12 157 matched controls. Likelihood ratios (LR) were used to classify tests or their combinations as useful rule-in tests (LR+ = ≥5), or rule-out tests (LR− = ≤0.2).Results Raised plasma viscosity (PV) had an LR+ = 2.0, 95% confidence interval [CI] = 1.7 to 2.3; erythrocyte sedimentation rate (ESR) 1.9, 95% CI = 1.7 to 2.0; and C-reactive protein (CRP) 1.2, 95% CI = 1.1 to 1.4. A normal haemoglobin had an LR− = 0.42, 95% CI = 0.39 to 0.45; calcium LR− = 0.81, 95% CI = 0.78 to 0.83; and creatinine LR− = 0.80, 95% CI = 0.77 to 0.83. The test combination with the lowest LR− was all normal haemoglobin with calcium and PV, which had an LR− = 0.06, 95% CI = 0.02 to 0.18, though the LR− for normal haemoglobin and PV together was 0.12 (95% CI = 0.07 to 0.23).Conclusion Plasma viscosity and ESR are better for both ruling in and ruling out the disease compared with C-reactive protein. A combination of a normal ESR or PV and normal haemoglobin is a simple rule-out approach for patients currently being tested in primary care. ER -