Blood samples are referred to the clinical laboratory by general practitioners and specialists alike, with the purpose of identifying possible monoclonal proteins in the serum sample. Often monoclonal bands are reported, but, after a full work-up patients do not fulfil the criteria of multiple myeloma. Monoclonal proteins in serum can be caused by a variety of diseases, including multiple myeloma, monoclonal gammopathy of undetermined significance, smouldering myeloma, Waldenstroms macroglobulinaemia, amyloidosis, heavy chain disease, solitary plasmacytoma, B-cell lymphoma, B-cell leukaemia. This communication aims to address the spectrum of specifically MGUS, SMM and multiple myeloma with recommendations with regards to diagnosis and follow up where a diagnosis of multiple myeloma is not initially made. 

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