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Smouldering Myeloma: Chasing a Hyperviscous Sample.

Amandeep Birdi1, Arun Sinha1, Mithu Banerjee1

  • 1Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India.

Indian Journal of Clinical Biochemistry : IJCB
|April 7, 2023
PubMed
Summary
This summary is machine-generated.

Serum hyperviscosity, a rare finding, can indicate underlying malignant disorders. This case highlights how abnormal serum viscosity in a patient led to the diagnosis of smoldering multiple myeloma.

Keywords:
Albumin-globulin ratioHyperviscosityMonoclonal gammopathySmoldering myeloma

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Area of Science:

  • Hematology
  • Oncology
  • Clinical Chemistry

Background:

  • Serum hyperviscosity is an uncommon laboratory finding, often associated with malignant conditions.
  • Monoclonal gammopathies encompass asymptomatic variants like monoclonal gammopathy of unknown significance (MGUS) and smoldering myeloma, as well as the symptomatic malignant form, multiple myeloma.
  • Early detection of monoclonal gammopathies is crucial for timely intervention and management.

Observation:

  • A patient's serum sample exhibited hyperviscosity during routine automated analysis, triggering clot detection alarms.
  • Initial investigations revealed normal D-dimer levels but mildly elevated fibrinogen and a significantly reversed albumin/globulin (A/G) ratio.
  • Physical examination showed pallor and anemia, with generalized weakness as the primary complaint.

Findings:

  • Serum electrophoresis demonstrated an M spike, a key indicator of monoclonal gammopathy.
  • Bone marrow aspirate revealed 13% plasma cells, supporting the diagnosis.
  • The combination of hyperviscosity, M spike, and bone marrow findings led to the diagnosis of smoldering multiple myeloma.

Implications:

  • This case underscores the importance of recognizing serum hyperviscosity as a potential red flag for underlying hematologic malignancies.
  • Thorough investigation of hyperviscous samples can lead to the early diagnosis of conditions like smoldering multiple myeloma.
  • Prompt identification of smoldering multiple myeloma allows for closer monitoring and timely initiation of treatment if progression occurs.