Hematology Case 8
Presented By Dr Shehab Sharaf Dr Mohammad Moharram
Released on 1-5-2019Patient Data
80 year old male
Clinical Data
Admitted with severe anemia for blood transfusion. Skeletal Survey shows bony lytic lesions
Related Laboratory Results
S. Calcium: 3.1 mmol/L (R.R.: 2.2 - 2.58)
S.Creatinine: 435 umol/L (R.R.: 55-113)
BUN: 22.4 mmol/L (R.R.: 2.5 - 6.4)
Hemoglobin: 5.5 g/dL (R.R.: 13-17)
Albumin: 28 g/L (R.R.: 35-50)
Total Protein: 92 g/L (R.R.: 65-81)
IgG: 5370 mg/dL (R.R.: 751-1560)
ESR: 140 mm/Hr (R.R.: 0-10).
Peripheral blood Smear Shows rouleaux formation
Provisional Diagnosis
Plasma Cell Neoplasm
Case Picture(s) / Photo(s)
Bone Marrow Aspirate
Bone Marrow Trephine Biopsy
H & E
CD 138
CD 56
Kappa
Lambda
Comment / Findings
B.M Aspirate: Mild Hyper-cellular B.M. for age. Increased relative number of plasma cells ≈ 12.5% of heterogeneous distribution and variable morphology (variable cell size, multi-nucleated , nuclear lobulation , cytoplasmic projections, plasmablastic appearance.) Mott cells are occasionally seen.
Bone marrow biopsy: Nodular and interstitial infiltration by sheets of plasma cells represent >60% of bone marrow cellularity. Plasma cells are positive for CD138, CD56, Kappa light chain and negative for Lambda light chain.
Final Diagnosis
Plasma Cell Myeloma (Multiple Myeloma)