It just goes to show that picking up on simple signs can lead to the start of a diagnostic journey. The patient with the film below (second from left) had a FBC as she had suffered from back pain and tiredness. The FBC showed she had anaemia and rouleaux which was why it was put forward for a comment. The film looked more purple than the others as a result of high levels of globulins.

The patient had an IgA kappa paraprotien of 32g/L and marrow biopsy confirmed the diagnosis of plasma cell myeloma.

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