Paraprotein

Borders Ref Help Toolkit
NHS Borders

Definition 

Paraprotein detected on immunoglobulin analysis – usually given immunoglobulin subtype (e.g. IgG Kappa).  May be only serum light chains (e.g. Lambda light chains).

Please also note that IgM paraproteins more often occur in the setting of lymphoma rather than myeloma.

Who to refer, who not to refer, how to refer

Who to refer:

  • Refer all patients with a paraprotein.  (In general, patients will be assessed in clinic; however, in some cases, advice on further investigation and/or management may be provided by correspondence)
  • URGENT referral for patients with possible myeloma – renal impairment, hypercalcaemia, hyperuricaemia, pathological fracture, bone pain, spinal cord compression

Who not to refer:

  • Polyclonal increase in immunoglobulins without a paraprotein.  This is most likely caused by chronic inflammatory or infective processes and does not require referral.

How to refer:

SCI Gateway – to Department of Haematology BGH

Primary care management

Primary care investigations

  • FBC
  • Biochemistry including renal function, liver function, calcium, albumin, urate
  • Serum free light chains if a paraprotein is detected

Editorial Information

Last reviewed: 21/11/2025

Next review date: 21/11/2027

Author(s): Charlotte Robertson.

Author email(s): HaematologyConsultants@borders.scot.nhs.uk.