P188 | IMPROVING THE DIAGNOSTIC PROCESS OF PLASMA CELL DYSCRASIAS: ADDRESSING KNOWLEDGE GAPS IN THE INTERPRETATION OF ELECTROPHORESIS ABNORMALITIES

The misinterpretation of electrophoresis (EF) abnormalities, especially monoclonal gammopathy of undetermined significance (MGUS), by non-hematology physicians and general practitioners (GPs) often leads to unnecessary hematology referrals and delays in the diagnostic process. We retrospectively analyzed 214 patients referred to our unit for EF abnormalities between January 2023 and October 2024. We also conducted a survey among non-hematology physicians, GPs, residents, and medical students to assess knowledge and clinical practices. About two-thirds of patients were referred due to monoclonal gammopathy and over 70% had a referral priority of 10 days or less. In a detailed analysis of 80 patients with complete data, we found 5 cases (6%) of symptomatic myeloma, 4 (5%) of smoldering myeloma, and 1 lymphoma. MGUS was diagnosed in about two-thirds of patients; 15% had other non-classifiable conditions. Most patients had EF and a complete blood count at first evaluation; however, only 25% had serum immunofixation, two-thirds had free light chain and immunoglobulin testing, and <40% had calcium levels. Urine analysis was done in 20%, and proBNP in only 5%. Bone marrow evaluation was performed in 15%. The identified cases of myeloma and lymphoma were not referred for hematologic evaluation with urgent priority. Survey responses (n=92) revealed that two-thirds considered monoclonal gammopathy the most frequent and concerning EF abnormality. While almost all linked EF abnormalities to myeloma, 25% also incorrectly associated them with all hematological diseases. Around two-thirds would request a hematology consultation, but only 15% would prescribe all key tests (immunofixation, free light chains, immunoglobulins), and <20% would request basic labs like CBC, calcium, and renal function. One-third of respondents felt unprepared to manage EF abnormalities, while over two-thirds expressed the need for improved education on EF interpretation across all stages of training (Fig. 1). Educational gaps and misconceptions persist in the interpretation of EF abnormalities. Enhancing diagnostic training and interdisciplinary communication may improve the management of plasma cell dyscrasias.