Case 27 – update 2

Thank you so far for your contributions via #TeamHaem on Twitter.  The start of case 27 can be found below…

The patient states she gets dizzy when standing up and indeed she has postural hypotension. This is attributed to her directic and ACEi use. The falls usually preceded by standing up, but are not helped by peripheral neuropathy. An ECG is requested.

The team requested iron studies, which have revealed:

  • Iron – 6mmol/L (10-28)
  • Tranferrin saturations 17%

Diagnosing anaemia of chronic disease is difficult and often the Hb, MCV, ferritin and other markers such as % hypochromic cells need to be used. This has been reviewed recently: http://onlinelibrary.wiley.com/doi/10.1111/bjh.12311/pdf

Further investigations has revealed a paraprotein in the gamma region and this has been typed as IgG lambda and quantified at 4.6g/L.  Glucose is normal.

Questions:

  • Small paraproteins in elderly patients are common. Does this need further investigation?
  • How do you ensure this is not plasma cell (multiple) myeloma?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Anaemia, Myeloma/paraproteins, Related to other specialities and tagged , , . Bookmark the permalink.

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