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The Significance of CRAB (Multiple Myeloma)


multiple myeloma crabWhat does astrology have to do with Multiple Myeloma? More than you might think. 

Cancer is the fourth sign of the zodiac spanning June 22 to July 22. The crab is the mascot of the Cancer zodiac sign. The letters C-R-A-B also stand for four clinical manifestations of Multiple Myeloma, a cancer of the blood resulting from the proliferation of malignant plasma cells. The presence of CRAB criteria are important diagnostic indicators of Multiple Myeloma. In 2003, the International Myeloma Working Group (IMWG) defined the CRAB criteria in the British Journal of Hematology(1). 

C stands for Calcium. Patients with Multiple Myeloma can have elevated levels of calcium (hypercalcemia) due to the breakdown of bone. Hypercalcemia resulting from Multiple Myeloma must be differentiated from other causes such as overactivity of the parathyroid glands, medications and excessive use of calcium and Vitamin D supplements.

R stands for Renal. Many patients with Multiple Myeloma have some degree of renal insufficiency at diagnosis. If untreated, patients with Multiple Myeloma can progress to a condition called myeloma kidney and may lose their kidney function completely. Patients with acute kidney injury (AKI) resulting from Multiple Myeloma need to be differentiated from those with AKI from other causes to make sure the correct treatment is initiated.

A stands for Anemia.  In Multiple Myeloma, cancerous plasma cells invade the bone marrow and can disrupt normal hematopoiesis or blood formation. This results in decreased red blood cell production and the condition called anemia. Anemic patients often complain of fatigue which is one of the common signs of Multiple Myeloma. 

B stands for Bone. Many patients with Multiple Myeloma have bone lesions. These lesions are caused by the destruction of bone in areas where cancerous plasma cells have made a niche in the bone marrow. In these areas malignant plasma cells cause the activation of osteoclasts that in turn, cause bone resorption and the release of calcium from the bone into the serum. The bone in these areas may be weakened and fractures are often an unwanted sequela.

Following routine laboratory evaluations (Freelite® serum free light chain assays, serum protein electrophoresis, immunofixation electrophoresis), it is important for clinicians to be able to differentiate CRAB conditions resulting from Multiple Myeloma from other causes. Individual CRAB criteria can be associated with many pathologies and the faster the root cause of symptoms are diagnosed, the faster the patient will receive appropriate treatment.

  1. Br. J Haematol 2003 Jun; 12: 749

4 Clinical Uses of the Ideal Biomarker


4 Clinical Uses of the Ideal Biomarker

There are a variety of biomarkers detected by lab tests, but not all of them are equal in their clinical utility. Using the clinical applications as outlined by the Biological Definitions Working Group *, an ideal biomarker can be used for all four of the following clinical uses or applications:

  • Identify a disease or abnormal condition

  • Stage a disease or classify the extent of disease

  • Indicate disease prognosis

  • Monitor clinical response to an intervention

For Multiple Myeloma and related disorders, the ideal biomarkers for identification, staging, prognosis, and monitoring are free light chains, the short protein chains on the antibody. There are two types of light chains: lambda (λ) chain, kappa (κ) chain. As ideal as free light chains are as biomarkers, they’re only as clinically useful as the test that is sensitive enough to detect them.

    clinical uses of the ideal biomarker       

Freelite® is a simple, quantitative blood test that is able to detect very high levels of free light chain concentrations, as well as very low concentrations into the normal range, allowing physicians the ability to quantitatively monitor disease response and relapse.  Freelite and serum protein electrophoresis (a lab test that detects intact immunoglobulins) provide 100% diagnostic sensitivity for Multiple Myeloma when combined.


The serum free light chain test (i.e., Freelite) is recommended by the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the International Myeloma Working Group (IMWG) for use in the initial diagnostic workup of Multiple Myeloma and related disorders.  

Interested in learning more?

Click here to request your FREE COPY of the IMWG Guidelines.

(*In order to provide clarity on what a biomarker is, an expert working group (Biological Definitions Working Group) was convened by the National Institutes of Health in 2001 and charged with defining the term biomarker and outlining, using consistent terminology, the potential clinical applications of biomarkers.  The BDWG defines a biomarker as: “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”)


10 Warning Signs of Immune Deficiency


10 Warning Signs of Immune Deficiency

Opportunistic pathogens (bacteria and viruses) that can cause infection are ubiquitous in our normal environment. 

 warning signs of immune deficiency

Normally, cells and protein mediators in immunocompetent individuals are able to kill pathogens before they cause serious illness. However, those people with a disease of the immune system such as Primary Immunodeficiency Disease (PID) can become seriously ill, sometimes with permanent damage to their organs, if they are not properly diagnosed and treated.

According to the World Health Organization there are more than 185 different manifestations of PID.

Though symptoms of Primary Immunodeficiency Disease can vary, frequent infection – particularly of sinuses, ears, and lungs – is common at an early age. The Jeffrey Modell Foundation (JMF) has developed a list of 10 warning signs of immune deficiency:

10 warning signs of immune deficiency  

warning signs for immune deficiency

JMF recommends that children and adults who are affected by two or more of these warning signs of immune deficiency should be evaluated for the possibility of an underlying Primary Immunodeficiency.

Testing for Primary Immunodeficiency

More than half of Primary Immunodeficiency Diseases are disorders resulting in antibody (immunoglobulin) deficiencies. Levels of immunoglobulin (IgA, IgG, IgD, IgE, IgM) and immunoglobulin subclasses (IgA1, IgA2, IgG1, IgG2, IgG3, IgG4) are easily measured by a simple blood test. Additional tests such as Vaccine Response to protein antigens (Tetanus Toxoid and/or Diphtheria Toxoid), protein conjugate antigens (Hib) and polysaccharide antigens (PCP) may be needed.

An additional group of proteins involved in the innate immune system are known collectively as Complement, which includes whole proteins and protein fragments C1 through C9. Once activated, the Complement system sets off a cascade of events resulting in destruction of a target cell. Individual Complement proteins can be measured as well as the overall functioning of the Complement system by a test called CH50.

To learn more about diagnostic tests available for Primary Immunodeficiency, contact Binding Site (


Visit Us at 2013 CIS Annual Meeting Booth #210

warning signs of immune deficiency

Going to ACP Internal Medicine 2013?


ACP Internal Medicine Meeting 2013  

The ACP Internal Medicine Meeting, will be held at the Moscone Center in San Francisco, CA with the Pre-courses from April 9-10 and the Scientific Program, Clinical Skills Center and Exhibits from April 11-13.

Binding Site will be exhibiting at the ACP meeting again this year to educate Internal Medicine doctors on the latest news about Myeloma, the second most prevalent blood cancer today.

 acp internal medicine meeting 2013

3 Little Known Facts about Myeloma:

  1. Myeloma is a difficult disease to diagnose as symptoms are non-specific and many patients present to their Internal Medicine physician before being referred to a Hematologist. 

  2. The NCCN and IMWG Guidelines recommend Freelite® alongside standard laboratory tests as an aid for the identification of monoclonal gammopathies, including Multiple Myeloma.*

  3. The late diagnosis of Multiple Myeloma can lead to significant complications, including fractures, infection and renal failure. 

Interested in learning how Freelite can benefit your practice?

Supplies are limited, so be sure to make Binding Site one of your first booth visits!

  acp internal medicine 2013 binding site golf balls
*Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma V.1.2013. © National Comprehensive Cancer Network, Inc. 2013. All rights reserved. Accessed April 5, 2013. To view the most recent and complete version of the guideline, go online to NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

Top 3 Reasons Why a Nephrologist Should Order Freelite


Why a Nephrologist Should Order Freelite

I have a confession to make: I rarely give my kidneys a second thought, probably because I have two and, thankfully, they both work fabulously.

However, if they were not working properly, you can bet that I would be quite aware of them, AND I'd want to make sure that I had a nephrologist who was aware of Freelite®.

What is Freelite, you might ask, and what does it have to do with kidneys? Allow me to explain in my Top 3 list below.

Top 3 Reasons Why a Nephrologist Should Order Freelite on All Patients with Unexplained Kidney Injury:

  1. Myeloma can be the cause of unexplained acute kidney disease; early identification of Multiple Myeloma as a cause of AKI can lead to an improved outcome for the patient.

  2. Freelite is a non-invasive blood test that is offered at all major reference labs. 

  3. The Freelite serum free light chain assay is the only test for quantifying serum free light chains.

If you're interested in reading more in-depth information about Freelite, and why a nephrologist should order Freelite for patients with unexplained kidney injury, check out this link:


     why a nephrologist should order freelite       

7 Symptoms To Make You Think: Multiple Myeloma


Why Think "Multiple Myeloma"?

think multiple myeloma

Patients with Multiple Myeloma are difficult to diagnose because they often present with diverse and non-specific symptoms.

7 Common Symptoms to Make You Think: Multiple Myeloma

  1. Bone pain due to fractures in back or ribs or elsewhere

  2. Feeling weak or tired

  3. Feeling very thirsty

  4. Frequent infections or fevers

  5. Unintentional weight loss

  6. Nausea

  7. Frequent urination

These symptoms could signal a wide variety of ailments, and Multiple Myeloma may be overlooked. Standard of care guidelines recommend running Freelite(R), a simple blood test, along with other prescribed laboratory tests to provide doctors with important information to aid in either diagnosing or ruling out Myeloma.

Dr. Tina Kuus, Managing Director of Scientific Affairs at Binding Site, says, “It’s rare to meet a patient who's even heard of Myeloma prior to their diagnosis. This is the primary reason for us to build awareness of the disease, especially during March, which is Myeloma Awareness Month. Earlier detection of Multiple Myeloma may help avoid complications such as acute renal injury."

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