Category Archives: Myeloma/paraproteins

Case 97 – Summary

This week we looked at a neuropathy presenting via the neurology team associated with a plasma cell dyscrasia. This area of haematology is often challenging! The diagnosis can be difficult and even after diagnosis there is a lack of evidence … Continue reading

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Case 97 – update 3

Thanks for your help so far with this case. so far we know our patient is a 54 year old male who presented to clinic with distal sensory loss and a broad based gait which has been slowly progressing over … Continue reading

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Case 97 – update 2

The bone marrow aspirate did appear to show an excess of Plasmacytoid and lymphoplasmacytoid cells. Immunophenotype results: Abnormal population: Kappa restricted B cell population = 18% of total nucleated cells. Immunophenotype: CD19+, CD5 negative, CD23 negative/wk, CD10 negative, CD103 negative, … Continue reading

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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” … Continue reading

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Case 97 – the beginning

Welcome to another #TeamHaem case You are in the Haematology new patient clinic and receive a letter from the local Neurology team asking you to assess a 54 year old male who has an Ig M kappa paraprotein of 6g/dl … Continue reading

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Case 91 – summary

Thank you for all your contributions this week! This week we had a look at MGUS (monoclonal gammopathy of undetermined significance). Our patient was diagnosed with IgA lambda MGUS, which was monitored 6 monthly for 4 years. This then progresses … Continue reading

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Case 91 – update 2

We have been monitoring our patient 6 monthly for 4 years. His para protein has been slowly rising and was 10g/l on his last visit 3 months ago. He has been bought to clinic slightly earlier to monitor his paraprotein. … Continue reading

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Case 91 – update 1

So our patient has been seen by haematology. He initially presented with shoulder pain. Following X-ray and MRI this has been shown to be due to osteoarthritis with no evidence of lytic lesions. Bone marrow had shown a normocellular marrow … Continue reading

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Case 91 – the beginning

Welcome to this week’s TeamHaem case! This week we start in general practice. A 70 year old man saw your colleague complaining of shoulder pain. Some bloods were done as he was due his ‘well man’ bloods around the same … Continue reading

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Case 88 – summary

Morphology week summary. Case A     Our followers were correct in suggesting these were plasma cells, one of which is binucleate on the second picture.  Thrombocytopenia was also noted.  This would be in keeping with a diagnosis of plasma … Continue reading

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Case 88 – part A

This week we are going to do some quick fire morphology cases. Cases will be centered around a blood film, then added questions based on the diagnosis our followers come up with. Please feel free to add interesting pictures of … Continue reading

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Case 85 – summary

So, our patient has had quite a week! Thanks to your efforts, he is safely back on the ward, conscious and improving.  Recap: We have managed an emergency presentation of an unconscious patient with severe hypercalcaemia, hyperviscosity and an AKI. … Continue reading

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Case 85 – update 2

We rejoin our patient on HDU… He remains unconscious and lacks capacity to currrently make decisions regarding his further management.  Based on our team’s suspicion of an underlying plasma cell disorder, that may be driving our patient’s hypercalcaemia, AKI and … Continue reading

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Case 85 – update 1

Thank you for all your help so far on the medical admissions unit. Assessment Our patient was initially assessed using an ABCDE approach: A) Snoring, requiring an airway adjunct (nasopharangeal airway) B) RR16, chest clear to auscultation, sats 97% room … Continue reading

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Case 85 – the beginning

Welcome to our new case. We need your help urgently. Our patient is a 55 year old man who is drowsy and confused. His friend is extremely worried and has brought him to the Medical Admissions Unit front door for … Continue reading

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Case 75 – summary

Case 75 – Summary! Thank you for all of the contributions with Case 75, where we encountered a 43 year old who presented with back pain and circulating plasma cells in his peripheral blood. In summary we established that this … Continue reading

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Case 75 – update 3

Bortezomib-based regimes are associated with better outcomes as it more rapidly reduces tumour load and reverses complications. What would you combine Bortezomib with in our patient? How would you consolidate this treatment if response achieved? Would the cytogenetics results influence … Continue reading

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Case 75 – update 2

Our patient has >2×109 plasma cells in peripheral blood without a history of myeloma consistent with a diagnosis of primary plasma cell leukaemia (pPCL). Flow is typical of  pPCL – myeloma markers with CD56- and CD20+. Our patient had a … Continue reading

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Case 75 – update 1

Thanks for everyones contributions. The following results are now back:   SFLC kappa: lambda ratio: 6543. Igs and serum electrophoresis: Immuneparesis and IgA kappa paraprotein 18 B2 microglobulin 8.7. Albumin 28. Bone marrow biopsy: 66% plasma cells morphologically. Flow cytometry … Continue reading

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Case 75 – the beginning

A 43 year old man presents to A+E with severe back pain. He also has a 2 month history of progressive fatigue. On examination he has pallor, splenomegaly and marked tenderness to L2-L5. How would you further assess this patient? … Continue reading

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