case 137 – Update 5

It is now nearly 3 years since our patient completed his treatment for myeloma and you noticed that he had started to become a little anaemic with Hb 97, neuts 1.9 and plts 120.

You asked for more information. Film showed MCV 112 but film fairly unremarkable otherwise. Renal, liver, bone profile, LDH, paraprotein and SFLCs normal.

You asked for a bone marrow biopsy. Some pictures are shown below:

What features do you note and what are your thoughts?

How would you risk stratify this patient and what further information do you require to do this?

How might you manage this patient?

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