Specimen Name Result Units Range
Plasma Sodium 132 mmol/L (135-145)
Potassium 4.0 mmol/L (3.5-5.5)
Chloride 108 mmol/L (100-109)
Bicarbonate 25 mmol/L (22-32)
Anion Gap 3 mmol/L (7-17)
Glucose 9.0 mmol/L (3.8-5.5)
Urea 14.5 mmol/L (2.7-7.2)
Creatinine 150 μmol/L (60-110)
Phosphate 1.02 mmol/L (0.80-1.45)
Total Calcium 2.40 mmol/L (2.10-2.55)
Albumin 27 g/L (34-48)
Total Protein 120 g/L (60-80)
Total Bilirubin 6 μmol/L (6-24)
GGT 43 U/L (< 60)
ALP 143 U/L (30-110)
ALT 30 U/L (< 55)
AST 55 U/L (< 45)
Blood Hb 111 g/L (130-180)
Platelets 198 x109/L (150-450)
WCC 8.7 x109/L (4.0-11.0)

43yo female with lower back pain.
Multiple Myeloma
  • ↑↑Globulins (IgG-M) → ↓↓AG
  • Mild hyponatraemia
  • Mild ↑ ALP
  • Ca++ normal - frequently elevated

Diagnosis

  • Marrow plasmacytosis > 10%
  • Lytic bone lesions, e.g. Skull X-Ray
  • Serum or urine M component

Clinical Features

  1. Bone lesions
    • pain is most common symptom
    • osteolytic without osteoblastic zone
    • 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 ≈ 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 +'ve charge → reduction in anion gap.
    • hyperproteinaemia → factitious hyponatraemia
  4. Marrow aspiration
  5. Skeletal radiological survey