An 84yearold woman resident of a nursing home was admitted t

An 84-year-old woman resident of a nursing home was admitted to the hospital for treatment of lower back pain resulting from a fall. Radiologic examination revealed a vertebral compression fracture. Because she demonstrated signs of general deterioration, further medical evaluation was performed. A neurologic examination and CT scan were normal. Serologic examinations for collagen vascular disease were also negative, although the CRP showed a modest increase. Serum protein electrophoresis was done to rule out multiple myeloma. The serum protein fractions were as follows: albumin, 3.2 g/dL; alpha_1-globulins, 0.31 g/dL; alpha_2-globulins, 1.59 g/dL (elevated in a tight band); beta-globulins, 0.72 g/dL; and gamma-globulins, 0.96 g/dL. What would the next step be in the evaluation of this patient? Given the following additional result (haptoglobin: 416 mg/dL), what condition would explain her abnormal protein electrophoresis pattern? What other proteins would you expect to be abnormal?

Solution

1.Further diagnostic tests like bone marrow biopsy, monoclonal protein in urine, bone lesions, osteoporosis, serum calcium levels are done.

2.Her albumn globulin ratio is reversed. gamma globulin levels are increased abnormally. Large number of unwanted antibodies are being produced. This explains the protein electrophoresis pattern. This is consistent with the multipple myeloma condition.

3. Myeloma protein level will be elevated