Case 97 – update 1

Thanks for your help so far

The neurology team contact you as they have the results of the Nerve conduction studies they performed a few weeks ago these show “prolonged conduction velocities consistent with demyelination in an axonal loss pattern”

The neurology team have also sent away for some further bloods looking at cause of demyelination

The results from your clinic are available. He had unremarkable FBC (Hb 14g/dl), U&E and LFT unremarkable. Albumen was within normal range at 42g/l. His B12 and folate are normal.

His serum electrophoresis confirmed an Ig M Kappa paraprotein of 6g/dl. Serum B2 Microglobulin 3.2mg/l (Normal <2mg/l). LDH 540u/l (reference range 240-450u/l)

24 hour urine protein with electrophoresis negative.

A CT CAP showed no lymphadenopathy or organomegaly. You have booked him in for a bone marrow this week.

What other blood tests have the neurology team sent for given the nerve conduction findings and Ig M PP?

What is the likely mechanism for the neuropathy in this case?

Would you be happy to leave the lumbar puncture at the moment as the patient is not keen?

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