Friday, November 30, 2007

All In

A 66 year old African American male presents with pain in his back and chest. The pain gets worse with movement and does not occur at night except when he changes position in bed. The patient also said that he used to be 6 feet, but now he's only 5'10". He also complains of weakness, tiredness, and some weight loss. You are unsure what is going on so you order some basic lab tests, including a peripheral blood smear (shown above). The abnormality is indicated by the arrow. Luckily, you remember seeing this in your hematology block.

Challenge: What's the clinical diagnosis?

Related Questions:
1. What's the finding on the peripheral blood smear called?

Image shown under fair use.


Alex said...

Rouleaux formation in multiple myeloma?

Craig said...

All In

The peripheral blood smear shows rouleaux formation, a sort of “stack-of-coins” appearance. This is classic for multiple myeloma, a neoplastic proliferation of a single clone of plasma cells producing a monoclonal antibody. The epidemiology and clinical symptoms support this diagnosis. Often, the clone of plasma cells proliferates in the bone marrow and results in extensive skeletal destruction. Other findings include anemia, hypercalcemia, and renal insufficiency.

Sources:; UpToDate.