Blood Chemistries

Abnormalities in blood chemistries reflect various organ dysfunctions and metabolic derangements and include elevated blood urea nitrogen, serum creatinine, calcium, and hepatic enzymes. Serum albumin level is often depressed consequent to specific transcriptional down-regulation of the albumin gene by IL-6 and other inflammatory cytokines.2728 The severity of hypoalbuminemia, correlated with the stage of disease, is an important prognostic factor.29 C-reactive protein, a surrogate marker for IL-6, and ^-microglobulin, a marker for myeloma tumor load, are increased in some patients.30 Elevated levels of serum lactic dehydrogenase, seen in 11% of untreated patients and more frequently in patients with high tumor mass, predict for chemoresistance and a shorter survival.31 A large amount of paraprotein in the serum causes reduced anion gap, "spurious" hyponatremia, and rarely, "spurious" hypercalcemia due to the binding of calcium by paraproteins.32

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