CONSULT REQUEST GUIDELINES                                                                         Print


Suggested Pre-Referral Evaluation and Management Guidelines
    Before referring patient to Myeloma Clinic:
  • The below labs should be ordered by the referring physician
  • Skeletal survey to assess for lytic lesions or MRI if directed by patient complaints.
  • Physician notes and prior labs from initial consultation to be sent before an appointment can be made.
Suggested Additional Test/Management Prior to Specialty Visit

Routine labs that may indicate Myeloma:

Comp - Comprehensive Metabolic Panel
CDP - Complete blood count differential platelet
LDH - Lactic Acid Dehydorgenase, serum
Uric Acid - Uric Acid, serum
UPEP - Urine, protein, electrophoresis
Viscosity -
B2 micro - Beta 2 Microglobulin, serum
TPE - total protein eletrophoresis
IFIX - immunofixation and total immunoglobulins
Monoclonal Gammopathy Evaluation
IFLC - Immunoglobulin Free Light Chains, serum
Pt - Prothrombin Time
Tsh - Thyroid Stimulating Hormone
24 hr. urine for PROTQ and BJQ - Protein, Urine
Patient Education/Information (includes preps)

For patient information including pre-appointment forms, maps & directions, participating insurance plans, and support:

Appointment Timeframe 2-3 weeks
How to Get Results to Consultant

UMHS patients: See MiChart
External patients: Fax referral and outside records, labs, and test results to 734-232-4900 Attention: Myeloma Clinic

Please send any bone marrow biopsy slides and/or skeletal surveys to:
Dept. of Hematology
B1- 358 Cancer Center
1500 E. Medical Center Dr.
Ann Arbor, MI 48109-0911
Clinic Contact Information Physicians: 800-962-3555
Patient: 734-764-1958
Clinic Location Sites Comprehensive Cancer Center - Ann Arbor
UM Consulting Physician Andrzej J. Jakubowiak, M.D., Ph.D.
Revised on: 02/10/2015



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