Category Archives: Myeloma/paraproteins

Case 62 – summary

Haematological emergencies   Patient A presented with an episode of neutropenic sepsis.  As a junior you should be suspicious of someone being neutropenic if they have had recent chemotherapy (usually within the past 1-2 weeks).  Reviewing patients previous blood results … Continue reading

Posted in Bone marrow failure, Myeloma/paraproteins | Tagged , , , , , ,

Case 62 – part B

Case B A 55 year old women attends the Haematology day unit where you are the junior reviewing emergencies.  She has a background of IgG MGUS.  She has noticed some difficult walking up the stairs over the past few weeks … Continue reading

Posted in Myeloma/paraproteins | Tagged , ,

Case 54 – summary

Case A Our first case looked at a blood film of a 48 year old gentleman who had presented with neutropenia and monocytopenia.  This is a common presentation for patients with hairy cell leukaemia and this leaves them susceptible to … Continue reading

Posted in Laboratory morphology, Lymphoma, Myeloma/paraproteins, Related to other specialities | Leave a comment

Case 54 – case D

  Case D 45 year old gentleman complaining of back pain. Hb 120 g/l, calcium 2.33 mmol/L, creatinine 75 IgG 34g/L Serum involved:non-involved light chains – 115 BM – 35% plasma cells MRI – no lytic lesions How would you … Continue reading

Posted in Myeloma/paraproteins | Tagged | Leave a comment

Case 50 part 3 – summary

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 … Continue reading

Posted in Laboratory morphology, Myeloma/paraproteins | Tagged , , | Leave a comment

Case 50 part 3 – the beginning

You are reviewing the blood films from today. Can you make a diagnosis without a microscope?     Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the … Continue reading

Posted in Laboratory morphology, Myeloma/paraproteins | Tagged , , | Leave a comment

Case 48 – #UnofficialCSIM2 summary

Thank you for joining the case. We’ve already met Mr Jones, a 75 year old man admitted following a fall to an orthopaedic ward with a fractured neck of femur. We agreed that his behaviour was new and odd and … Continue reading

Posted in Myeloma/paraproteins, Related to other specialities | Tagged , , , | Leave a comment

Case 48 – #UnofficialCSIM2 update 1

Thanks for joining the case, where as a surgical FY1 doctor you were asked to review Mr  Jones, a 75 year old man who had been admitted after a fall leading to a femur fracture. The nurses were worried that … Continue reading

Posted in Myeloma/paraproteins | Tagged , , , | Leave a comment

Case 48 – UnofficialCSIM2 – oncology week

Hi to all those joining us from #unofficialCSIM2. To remind our usual teamhaem-ers again – the #unofficialCSIM2 project is aimed at 4th year medical students. Whilst everyone’s input is appreciated, it would be helpful if those of you with more … Continue reading

Posted in Myeloma/paraproteins, Related to other specialities | Tagged , , , | Leave a comment

Case 47 – summary

Thank you for all your help with this weeks case! We have had some very helpful renal input this week! This week we looked at the case of a normally fit 60year old gentleman who presented with peripheral oedema and … Continue reading

Posted in Myeloma/paraproteins, Related to other specialities | Tagged , , , | Leave a comment

Case 47 – update 2

So we have another update on our gentleman. He has been found to have nephrotic syndrome and a renal biopsy has been performed which has now come back and is consistent with AL Amyloid nephropathy. Further investigations revealed an IgG … Continue reading

Posted in Myeloma/paraproteins | Tagged , , , | Leave a comment

Case 47 – update 1

Here is our first update on our 60 year old gentleman, who only has childhood asthma in his pmh. He initially presented with ankle swelling and despite 20mg furosemide he felt it was getting slightly worse at his second visit. … Continue reading

Posted in Myeloma/paraproteins | Tagged , , , | Leave a comment

Case 47 – the beginning

Welcome to our new case! This week we start in a GP surgery. Our patient is a 60 year old gentleman who has come to see you with some ankle swelling.  He saw your partner 4 weeks ago with the … Continue reading

Posted in Myeloma/paraproteins, Related to other specialities | Tagged , , | Leave a comment

Case 27 – summary

This case was all about evaluating a patient with a paraprotien.  A paraprotein is a specific immunoglobulin produced by a clone of plasma or lymphoid cells.  The immunoglobulin is composed of heavy chain and a light chain (either kappa or … Continue reading

Posted in Laboratory morphology, Myeloma/paraproteins | Tagged , , | Leave a comment

Case 27 – update 5

Our patient has a small IgG lambda paraprotein along with plasma cells in the marrow.  She has orthostatic hypotension, peripheral neuropathy and heart failure. Because of this the team were keen to investigate the possibility of amyloidosis. In order to … Continue reading

Posted in Myeloma/paraproteins, Related to other specialities | Tagged , | Leave a comment

Case 27 – update 4

When evaluating the patient with a paraprotein it is important to rule out conditions that require treatment such as myeloma, amyloid and plasmacytoma. The patient did not have any end organ damage attributable to myeloma. However we were concerned that … Continue reading

Posted in Myeloma/paraproteins | Tagged , , | Leave a comment

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 … Continue reading

Posted in Myeloma/paraproteins | Tagged , | Leave a comment

Case 27 – update 2

Thank you so far for your contributions via #TeamHaem on Twitter.  The start of case 27 can be found below… The patient states she gets dizzy when standing up and indeed she has postural hypotension. This is attributed to her … Continue reading

Posted in Anaemia, Myeloma/paraproteins, Related to other specialities | Tagged , , | Leave a comment

Case 27 – update 1

Our team wondered whether this was an ‘anaemia of chronic disease’ e.g. due to an inflammatory state. Investigations from the GP showed CRP 8mg/L (normal <5), ESR 67mm/Hr. The patient was previously investigated for a peripheral neuropathy and had B12 … Continue reading

Posted in Anaemia, Myeloma/paraproteins, Related to other specialities | Tagged | Leave a comment

Case 27 – the beginning

Welcome to #teamhaem! The rules are simple… we post a case on this site and then people comment on Twitter by replying to @teamhaem and using #teamhaem so everyone else can follow the conversation. Join in! A 76 year old … Continue reading

Posted in Anaemia, Myeloma/paraproteins, Related to other specialities | Tagged , , | Leave a comment