Case 27 – update 3

Our anaemic patient has a small paraprotein (IgG lambda, 4.6g/L). When finding a paraprotein it is important to think of the differentials:

  • MGUS
  • Asymptomatic myeloma
  • Plasma cell myeloma AKA multiple myeloma or simply myeloma
  • Non-Hodgkin lymphoma (e.g. Waldenström’s macroglobulinaemia)
  • POEMS syndrome (polyneuropathy, organomeglay, endocrinopathy, M protein, skin)
  • Bone or extramedullary plasmacytoma
  • Amyloid

In order to diagnose myeloma there needs to be end organ damage. The so-called CRAB features:

  • Hypercalcaemia
  • Renal failure
  • Anaemia
  • Bone lesions

She is anaemic but has a number of reasons to be so and has no other features clinically. She has no palpable lymphadenopathy and no other symptoms of lymphoma. POEMS syndrome is rare and the symptoms do not fit.

A number of our followers have raised the possiblity of amyloid….

Questions

  • What are the symptoms of amyloid?
  • What further investigations does the patient need to rule out 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.

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