Multiple Myeloma Case

A 53-year-old male patient with an established diagnosis of IgG λ multiple myeloma was seen by a hematologist–oncologist in consultation from an outside hospital. He had previously received 1 cycle of chemotherapy treatment, but he was found to be intermittently noncompliant with his therapy. The patient reported occasional nosebleeds and fatigue. Except for a slightly cachectic appearance, the physical examination was unremarkable. Laboratory results are shown in the image.

Serum protein electrophoresis revealed monoclonal paraproteinemia in high abundance marked by an intense band in the γ region. Immunofixation electrophoresis was not ordered at that time, but it was previously performed at another institution and was positive for IgG monoclonal protein. The attending pathologist noted the discrepancy between the presence of a monoclonal band by serum protein electrophoresis and the patient's quantitative immunoglobulin measurements. Several additional suspicious test results were also noted.

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Unexpected Test Results in a Patient with Multiple Myeloma

Source: Clinical Chemistry