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.StudiesResultsRoutine laboratory dataNormal except as indicated belowCBC, p. 174WBCs = 24,000 (normal: 5000-10,000)Hgb = 8.2 (normal: 14-18 g/dL)Hct = 25 (normal: 42%-52%)Differential indicates increase in mononuclear cellsAlbumin, p. 4242.8 g/dL (normal: 3.5 to 5)Protein electrophoresis, p. 424Immunoglobulin spikeImmunofixationSpike in beta 2 microglobulinBeta-2 microglobulin, serum, p. 3624.2 g/mL (normal: 0.70-1.80 mcg/mL)Multiple myeloma, urine, p. 9114000 mcg/L (normal: less than 300 mcg per mL)Laboratory cytogenetics, p. 161Deletion noted in chromosome 13Multiple genetic translocations notedX-ray, right hip, p. 1006Multiple radiolucent spots in the right ileum and femur
Diagnostic AnalysisThis 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 Questions1. 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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