Specimen Name Result Units Range
Plasma Sodium 133 mmol/L (135-145)
Potassium 4.0 mmol/L (3.5-5.5)
Chloride 107 mmol/L (100-109)
Bicarbonate 25 mmol/L (22-32)
Urea 14.0 mmol/L (2.7-7.2)
Phosphate 1.41 mmol/L (0.80-1.45)
Total Calcium 3.84 mmol/L (2.10-2.55)
Albumin 32 g/L (34-48)
Total Protein 120 g/L (60-80)
ALP 92 U/L (30-110)

59yo female with severe back pain.

FBE revealed anaemia.
Multiple Myeloma
  1. Hypercalcaemia
  2. Low AG - IgG-M component
  3. Hyponatraemia

Diagnosis

  1. Marrow plasmacytosis > 10%
  2. Lytic bone lesions
  3. Serum or urine M component

Clinical Features

  1. Bone lesions
    • pain is most common symptom
    • osteolytic without osteoblastic zone, e.g. Skull X-Ray
    • pathological fractures
  2. Infection
    • recurrent infection presenting complaint in 25%
    • may be significant hypogammaglobulinaemia
      (when M component excluded)
  3. Hypercalcaemia
    • renal failure - nephrocalcinosis
    • toxic effects of light chains
  4. Hyperviscosity syndrome
    • fatigue, headaches
    • visual disturbances, retinopathy
  5. Haematological
    • anaemia in 80%
    • granulocytopaenia & thrombocytopaenia rare
    • coagulopathy
    • may have cryoglobulins

Investigation

  1. CBE
  2. Plasma electrophoresis ± urine / quantitative
  3. Plasma electrolytes
    • calcium, urea, creatinine
    • M component = IgG
    • IgG has net +'ve charge → ↓AG
    • hyperproteinaemia → factitious hyponatraemia
  4. Marrow aspiration
  5. Skeletal radiological survey