CASE STUDY # 3 MULTIPLE MYELOMA
Pagana: Mosbys Manual of Diagnostic and Laboratory Tests, 5th Edition
Multiple Myeloma
Case Studies
A 64-year-old physician recently noted excessive tiredness throughout the day. He also complained of right hip/buttock pain. This prompted laboratory testing. On physical examination he was found to have an elevated heart rate (100 per minute) and appeared pale.
Studies
Results
Routine laboratory data
Normal except as indicated below
CBC, p. 174
WBCs = 24,000 (normal: 5000-10,000)
Hgb = 8.2 (normal: 14-18 g/dL)Hct = 25 (normal: 42%-52%)Differential indicates increase in mononuclear cells
Albumin, p. 424
2.8 g/dL (normal: 3.5 to 5)
Protein electrophoresis, p. 424
Immunoglobulin spike
Immunofixation
Spike in beta 2 microglobulin
Beta-2 microglobulin, serum, p. 362
4.2 g/mL (normal: 0.70-1.80 mcg/mL)
Multiple myeloma, urine, p. 911
4000 mcg/L (normal: less than 300 mcg per mL)
Laboratory cytogenetics, p. 161
Deletion noted in chromosome 13
Multiple genetic translocations noted
X-ray, right hip, p. 1006
Multiple radiolucent spots in the right ileum and femur
Diagnostic Analysis
This patient has marked anemia associated with elevated mononuclear (plasma) cell count. The RBCs are reduced because of the tumor burden affecting the marrows ability to make RBCs. Elevated levels of beta-2 microglobulin are noted, compatible with multiple myeloma. Laboratory cytogenetics supports the finding. The radiolucent changes noted in the right hip are the cause of his pain. The physician received aggressive chemotherapy that was successful in reducing his protein markers for 2 years. Unfortunately, he relapsed. He required further chemotherapy and bone marrow transplantation. He is now doing well and is quite active.
Critical Thinking Questions
2.What are the risks of the disease affecting the patients bones?
3.What is the name of proteins commonly in the urine of patients with multiple myeloma?
4.Why was the albumin abnormally low?
5.What tests will be used to monitor this mans disease?
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