Paraprotein-induced Discordance Between Direct and Total Bilirubin Levels in Patients with Myeloma: a Case Study Series

This study represents a preliminary investigation into the clinical implications of discordance between total and direct bilirubin levels in patients with multiple myeloma. Four cases are presented to highlight the variability in paraprotein concentrations and the discordance of total and direct bilirubin levels, emphasizing the importance of the timing of these measurements. The results of the bilirubin level discrepancy were observed either before the official diagnosis of multiple myeloma, or immediately after diagnosis, meaning before the initiation of chemotherapy for multiple myeloma.