Haematology Case Study Assignment

Haematology Case Study Assignment

A
57
year-­-old
female
presented
to
her
GP
with
a
history
of
fatigue,
weight
loss
and
increasingly
severe
back
pain.
On
examination
she
appeared
pale
with
no
signs
of
hepatomegaly
or
splenomegaly..
Table
1
Laboratory
Test
Results
Test
Result
Reference
Range
RBC
2.82
x
1012/L
3.8-­-5.8
x1012/L
HGB
7.6
g/dL
11.5-­-16.5
g/dL
HCT
0.239
L/L
0.37-­-0.47
MCV
84
fL
80-­-96
fL
MCH
26.9
pg
27-­-32
pg
MCHC
31.8
g/dL
32-­-36
g/dL
RDW
16.8
12-­-16
PLT
423
x
109/L
150-­-400
x109/L
WBC
8.4
x
109/L
4.0-­-11.0
x109/L
Differential:
Neutrophils
5.04
x
109/L
2.0
–
7.5
Lymphocytes
2.18
x
109/L
1.3
–
3.35
Monocytes
1.10
x
109/L
0.2
–
0.8
Eosinophils
0.08
x
109/L
0.04
–
0.44
Basophils
0.08
x
109/L
0.0
–
0.1
Blood
Film:
Normocytic
normochromic
with
occasional
hypochromic
cells.
Moderate
rouleaux
formation
Bone
Marrow
Aspirate:
Plasma
cells
with
variable
morphology
present.
Bone
Marrow
Trephine:
Hypercellular
with
clusters
of
plasma
cells.
Immunohistochemical
staining
for
?/?
shows
sheets
of
?
with
few
?
restricted
cells.
Chemistry:
Total
Protein
11.0
g/dL
Serum
protein
electrophoresis:
Albumin
Globulins:
a1
a2
ß
?
3.2
g/dL
0.4
g/dL
1.0
g/dL
0.8
g/dL
5.8
g/dL
5.2-­-8.3
g/dL
0.1-­-0.5
g/dL
0.5-­-1.2
g/dL
0.5-­-1.1
g/dL
0.6-­-1.7
g/dL
Monoclonal
protein
(in
g
fraction)
5.5
g/dL
IgA
9
mg/dL
85-­-450
mg/dL
IgG
5800
mg/dL
800-­-1700
mg/dL
IgM
25mg/dL
60-­-370
mg/dL
Radiography
demonstrated
multiple
lesion
of
the
skull,
spine,
pelvis
and
femurs.
The
patient
began
treatment
with
combination
therapy
of
melphalan
and
thalidomide,
with
radiotherapy
support
treatment
of
bone
pain.
Questions
1. Appraise
the
results
and
identify
the
diagnosis.
2. Explain
with
reference
to
the
clinical
and
laboratory
data
the
pathophysiology
of
this
disease.
3. Identify
possible
treatment
modalities
for
this
patient
and
others
like
her.

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