<prompt> Which of the following is seen in multiple myeloma: March 2007Raised serum calciumDecreased serum calciumNormal serum calciumNone of the above  <response>: Ans: A: Raised Serum Calcium Multiple myeloma MM myeloma plasma cell myelomaKahlers disease is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. The peak age of onset of multiple myeloma is 65 to 70 years of age. Multiple myeloma affects slightly more men than women. A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB ? C Calcium elevated, R Renal failure, A Anemia, B Bone lesions. Myeloma bone pain usually involves the spine and ribs, and worsens with activity. Myeloma bone disease is due to proliferation of tumor cells and release of IL-6, which stimulates osteoclasts to break down bone. The breakdown of bone also leads to release of calcium into the blood, leading to hypercalcemia and its associated symptoms. These bone lesions are lytic in nature and are best seen in plain radiographs, which may show punched-out resorptive lesions. The anemia found in myeloma is usually normocytic and normochromic. The presence of unexplained anemia, kidney dysfunction, a high erythrocyte sedimentation rate ESR and a high serum protein especially raised immunoglobulin should raise the suspicion. Protein electrophoresis of the blood and urine may show the presence of a paraprotein monoclonal protein, or M protein band, with or without reduction of the other normal immunoglobulins known as immune paresis. One type of paraprotein is the Bence Jones protein which is a urinary paraprotein composed of free light chains. Multiple myeloma can produce all classes of immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM. IgD and IgE myeloma are very rare. Myeloma activity sometimes appear as lytic lesions with local disappearance of normal bone due to resorption, and on the skull X-ray as punched-out lesions pepper pot skull. 