This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Which is not seen in multiple myeloma : 
Select and explain. 
A. Anemia, B. Increased alkaline phosphatase, C. Hypercalcemia, D. Increased ESR
B: Increased alkaline phosphatase
Answer: B: Increased alkaline phosphatase 
Explanation: Answer is B (Increased in alkaline phosphatase) Serum alkaline phosphatase is usually normal even with extensive bone involvement because of the absence of aslet)hractfr fictivity - Harrison 16th/ 659 Laboratory parameters in multiple myeloma : Anaemia: Normocytic normochromic ESR : markedly increased Hypogammaglobulinemiae Monoclonal spike on Serum protein electrophoresis - Monoclonal Gammopathy (M Band) Bone marrow replacement of normal marrow elements by plasma cells. Bence Jones Proteinuria: Light chain proteinuria (inclomplete IgG) Uric Acid level : Elevated due to increased cell turnover Serum calcium : Elevated Alkaline phosphatase : Normal Neutropenia & Thrombocytopenia rare