Case 93

1. Presented by Liz Crowe MD, PhD and reviewed by Lorraine N. Blagg, MA, MLS(ASCP)SBB

Clinical vignette
A middle-aged adult presents as transfer from an outside hospital with back pain, anemia and renal dysfunction for evaluation of monoclonal gammopathy with elevated serum IgM and serum viscosity (results below). A vertebral biopsy was reviewed and showed involvement by plasma cell neoplasm. The patient denies dizziness, headache, vision change, and epistaxis. Their current complaints are low back pain and hematuria. The apheresis service was consulted to start therapeutic plasma exchange for the indication of hyperviscosity in hypergammaglobulinemia.

Laboratory Studies are as follows:

Serum protein electrophoresis (SPEP) demonstrated an M-spike in the gamma region, which was quantified as >5 g/dL.

Question: What is the most likely explanation for the change in patient's serum IgM results?


16 thoughts on “Case 93”

  1. وجد العديد من أنواع المبيدات التي يمكن استخدامها للسيطرة على الصراصير. بعضها على شكل طعم ، والبعض الآخر على شكل سائل ، يتم توزيعها في الأماكن التي توجد فيها الصراصير في المطبخ ، على سبيل المثال ، خلف الثلاجة ، تحتها ، في خزائن المطبخ والزوايا ، خلف الغسالات ، بحيث تحمل الصراصير الطعم إلى أعشاشها ، بعيدا عن الأطفال. الابتعاد عن الأطفال إذا كان هناك حيوانات أليفة في المنزل ، لأنها قد تشكل خطرا عليهم.
    يساعد السكر على جذب الصراصير ، ويساعد حمض البوريك على قتلها ، لذلك يمكن خلط هاتين المادتين معا لعمل لقاحات للمنزل ، وتخليصه من الصراصير إلى الأبد ونشرها حيث توجد الحشرات. حمض البوريك ليس ساما للإنسان والحيوان ، ولكن يجب إبعاده عن المناطق المفتوحة والأماكن التي يتم علاجها يوميا لتجنب ملامسة اليدين والقدمين والملابس.

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