Chart-13

A 60 year old male presented with history of fracture bone after trivial injury

X-Ray skull:  Multiple punched out osteolytic lesions 

Laboratory findings: 

Hemoglobin       - 8 gm/dl; ESR- 110mm at the end of 1 hour

Urine  Protein   - 3+ 

The abnormal protein precipitated on heating urine at 60 0 C, disappeared on further heating and reappeared on cooling to lower temperature. 

PERIPHERAL BLOOD SMEAR

BONE MARROW 

A. Interpret the peripheral blood smear and the bone marrow aspiration smear. 

1. Peripheral Blood Smear 

• RBCs- normocytic normochromic, increased rouleaux formation seen 

• WBCs- normal in number with occasional plasma cells 

• Platelets- adequate 

2. Bone marrow- an increase in the plasma cells (more than 20%) with occasional cells showing binucleation 

B. What is your diagnosis? 

Multiple Myeloma 

C. What other tests would you like to do? 

1. Serum Electrophoresis for M protein 2. Urine for Bence Jones proteins 3. Serum Calcium 

2. Urine for Bence Jones protiens

3. Serum Calcium