Table 1.
| Result name | Results | Reference range |
|---|---|---|
| WBC | 2.9 K/mm cu | 4.2–11.0 |
| Platelet | 156 K/mm cu | 140–400 |
| Hemoglobin Hb | 9.0 g/dL | 12.0–15.0 |
| Hematocrit | 27.1% | 36.0–47.0 |
| Reticulocyte | 0.7% | 0.5–2.8 |
| Blood urea nitrogen | 22 mg/dL | 5–20 |
| Creatinine | 1.11 mg/dL | 0.0–1.00 |
| Sodium | 143 mmol/L | 135–145 |
| Potassium | 4.0 mmol/L | 3.4–5.1 |
| Chloride | 104 mmol/L | 98–109 |
| Bicarbonate | 33 mmol/L | 23–31 |
| Calcium | 13.3 mg/dL | 8.4–10.5 |
| Total protein | 7.0 g/dL | 6.4–8.3 |
| Albumin | 4.0 g/dL | 3.4–5.2 |
| Aspartate amino transferase | 20 IU/L | 0–32 |
| Alanine amino transferase | 10 IU/L | 0–40 |
| Alkaline phosphatase | 67 IU/L | 35–104 |
| Bilirubin total | 0.2 mg/dL | 0–10.0 |
| Haptoglobin | 157 mg/dL | 36–195 |
| Vitamin B12 | 532 pg/mL | 211–946 |
| TSH | 1.160 uIU/mL | 0.400–5.400 |
| Vitamin D25 OH | 47.0 ng/mL | 30.0–100.0 |
| 25 Hydroxy D3 | 26 pg/mL | |
| 25 hydroxy D2 | <8 | |
| Vitamin D 1,25(OH)2 | 26 | 18–72 |
| Folate | >20.0 ng/mL | 3.1–17.5 |
| Ferritin | 64 ng/mL | 13–150 |
| Phosphorous | 2.8 mg/dL | 2.0–4.0 |
| Lactate dehydrogenase | 137 IU/L | 135–214 |
| Total iron | 30 ug/dL | 30–160 |
| Unsaturated IBC | 234.0 ug/dL | 110.0–370.0 |
| Total IBC | 264.0 | 228.0–428.0 |
| Percentage of iron saturation | 11% | 20–55 |
| PTH intact on day of presentation | 70.5 pg/mL | 15.0–65.0 |
| PTH 7 months later | 540.0 pg/mL | |
| PTH-related protein | 18 pg/mL | 14–27 |
| Beta-2 microglobulin | 3.3 mg/L (5.8 mg/L four months later) | 0.8–2.2 |
| Serum viscosity | 1.5 relative to H2O | 1.5–1.9 |
| PT/INR | 10.6/1.0 sec | 9.211.8/0.9–1.1 |
| APTT | 29 sec | 24–33 |
| Immunoglobulins | ||
| IGA | 29 mg/dL | 50–400 |
| IGG | 692 mg/dL (1200, 5 months later) | 600–1500 |
| IGM | 6 mg/dL | 50–300 |
| Free kappa light chains | 1510 | 3.3–19.4 mg/L |
| Free lambda light chains | 2.4 | 5.7–26.3 |
| Free Kappa/lambda | 629.17 | 0.26–1.65 |
| Urine protein electrophoresis | ||
| Urine volume 24 hours | 1150 mL/24 hour | |
| Urine-protein electrophoresis (UPE) | 253 mg/24 hour | 0–165 |
| Albumin UPE | 30.6% | |
| Alpha1 | 16.1% | |
| Alpha2 | 14.1% | |
| Beta | 17.1% | |
| Gamma | 22.1% | |
| Immunofixation | Free kappa light chains | |
| 24-hour-urine protein | 310.5 mg/24 hour | 0–150 |
| 24-hours-urine creatinine | 0.7 g/24 hour | 0.74–1.57 |
| 24-hour-urine volume | 1150 cc | |
| 24-hour-urine creatinine | 0.5 g/24 hour | 0.74–1.57 |
| 24-hour-urine volume | 900 mL (repeat test) | |
| 24-hour-urine calcium | 239 mg/24 hour | 100–300 |
| Serum protein electrophoresis | ||
| Albumin | 3.3 g/dL | 3.1–5.0 |
| Alpha 1 | 0.3 g/dL | 0.2–0.5 |
| Alpha2 | 0.7 g/dL | 0.5–1.1 |
| Beta | 0.6 g/dL | 0.6–1.1 |
| Gamma | 1.5 g/dL | 0.7–1.7 |
| Albumin/globulin | 1.0 | |
| M spike | 1.09 g/dL | |
| Total protein | 6.5 g/dL | 6.4–8.3 |
| Immunofixation | Monoclonal paraprotein of class IgG kappa | |
| CD56 NK cells | 63% | 3–35 |
| CD 138 marker | 26% | |
| Lambda B-cell marker | 1% | 1–7 |
| Kappa B-cell marker | 73% | 2–14% |
| CD45 LCA | 98% | 92–100 |
| CD38 Marker | 26% | 1–17 |
Pathology. Normal female bone marrow karyotype. No clonal, structural, or numerical chromosome abnormalities identified. FISH analysis indicates normal hybridization signals with MM probe panel. This excludes majority of chromosome rearrangements known to be associated with MM.
Surgical Pathology. Mildly hyper cellular bone marrow with plasmacytosis consistent with MM.
Leukemia/lymphoma panel. Bone marrow aspirate shows 30–40% plasma cells with kappa light chain restrictions. (plasma cell dyscrasia).
Peripheral Smear. Lymphocytes with foamy cytoplasm, no rouleaux formation, adequate polys with occasional platelet clumps.