A 55-year-old male presented with bone pain in his spine and chest in addition to extreme...

A 55-year-old male presented with bone pain in his spine and chest in addition to extreme fatigue and anemia. The clinician ordered several tests with the following results:

Lab Report

Hemoglobin: 9.7 (13.8 - 17.2 g/dL)

Calcium: 11.4 (8.5 - 10.2 mg/dL)

Creatinine clearance: 35 (97 - 137 mL/min)

Total Protein: 8.1 (6.0 - 8.0 g/dL)

Albumin: 3.3 (3.5 - 5.5 g/dL)

SPE: monoclonal IgA (1.5 g/dL)

Bence-jones proteins present in urine.

What is the patient's likely condition, given the reports and calculated lab value? Describe the significant parameter which led you to this conclusion.

How is the SPE specifically used in this case to diagnose the disorder? Describe how this would appear different than a normal result.

Describe any additional testing that may be used to confirm the diagnosis.

What test might be used as a prognostic indicator? What results would indicate a better prognosis?

Solutions

Expert Solution

1. Tge likely diagnosis for patient is multiple myeloma. In Multiple myeloma, serum protein electrophoresis shows para protein. The common paraprotein are Bence Jones protein in urine. Other paraprotein are IgG, IgA, IgM

2. In Multiple myeloma, serum protein electrophoresis shows para protein. The common paraprotein are Bence Jones protein in urine. Other paraprotein are IgG, IgA, IgM.

3. SPE is used to measure total protein in the serum.

Normal value ranges are:

Total protein: 6.4 to 8.3 grams per deciliter (g/dL) or 64 to 83 grams per liter (g/L)
Albumin: 3.5 to 5.0 g/dL or 35 to 50 g/L
Alpha-1 globulin: 0.1 to 0.3 g/dL or 1 to 3 g/L
Alpha-2 globulin: 0.6 to 1.0 g/dL or 6 to 10 g/L
Beta globulin: 0.7 to 1.2 g/dL or 7 to 12 g/L
Gamma globulin: 0.7 to 1.6 g/dL or 7 to 16 g/L
Paraproteins like Bence Jones protein is not seen in normal conditions

4. Serum calcium shows raised levels due to bone resorption

Serum creatinine are raised due to impaired kidney function

Bone marrow biopsy

Quantitative measurement of IgG, IgA,IgM

5. Cytogenetic analysis of myeloma cells can be used as prognostic indicator

6. plasma cell labelling index (PCLI) shows how fast myeloma cells are multiplying. High PCLI shows poor prognosis while low PCLI show good prognosis.

High albumin show better prognosis

Low level of beta-2-microglobulin show good prognosis while high level show poor prognosis.

Nightingale answered 1 year ago

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