A Case of Multiple Myeloma Coexisting with Primary Hyperparathyroidism and Review of the Literature
Table 1
Result name
Results
Reference range
WBC
2.9 K/mm cu
4.2–11.0
Platelet
156 K/mm cu
140–400
Hemoglobin Hb
9.0 g/dL
12.0–15.0
Hematocrit
27.1%
36.0–47.0
Reticulocyte
0.7%
0.5–2.8
Blood urea nitrogen
22 mg/dL
5–20
Creatinine
1.11 mg/dL
0.0–1.00
Sodium
143 mmol/L
135–145
Potassium
4.0 mmol/L
3.4–5.1
Chloride
104 mmol/L
98–109
Bicarbonate
33 mmol/L
23–31
Calcium
13.3 mg/dL
8.4–10.5
Total protein
7.0 g/dL
6.4–8.3
Albumin
4.0 g/dL
3.4–5.2
Aspartate amino transferase
20 IU/L
0–32
Alanine amino transferase
10 IU/L
0–40
Alkaline phosphatase
67 IU/L
35–104
Bilirubin total
0.2 mg/dL
0–10.0
Haptoglobin
157 mg/dL
36–195
Vitamin B12
532 pg/mL
211–946
TSH
1.160 uIU/mL
0.400–5.400
Vitamin D25 OH
47.0 ng/mL
30.0–100.0
25 Hydroxy D3
26 pg/mL
25 hydroxy D2
<8
Vitamin D 1,25(OH)2
26
18–72
Folate
>20.0 ng/mL
3.1–17.5
Ferritin
64 ng/mL
13–150
Phosphorous
2.8 mg/dL
2.0–4.0
Lactate dehydrogenase
137 IU/L
135–214
Total iron
30 ug/dL
30–160
Unsaturated IBC
234.0 ug/dL
110.0–370.0
Total IBC
264.0
228.0–428.0
Percentage of iron saturation
11%
20–55
PTH intact on day of presentation
70.5 pg/mL
15.0–65.0
PTH 7 months later
540.0 pg/mL
PTH-related protein
18 pg/mL
14–27
Beta-2 microglobulin
3.3 mg/L (5.8 mg/L four months later)
0.8–2.2
Serum viscosity
1.5 relative to H2O
1.5–1.9
PT/INR
10.6/1.0 sec
9.211.8/0.9–1.1
APTT
29 sec
24–33
Immunoglobulins
IGA
29 mg/dL
50–400
IGG
692 mg/dL (1200, 5 months later)
600–1500
IGM
6 mg/dL
50–300
Free kappa light chains
1510
3.3–19.4 mg/L
Free lambda light chains
2.4
5.7–26.3
Free Kappa/lambda
629.17
0.26–1.65
Urine protein electrophoresis
Urine volume 24 hours
1150 mL/24 hour
Urine-protein electrophoresis (UPE)
253 mg/24 hour
0–165
Albumin UPE
30.6%
Alpha1
16.1%
Alpha2
14.1%
Beta
17.1%
Gamma
22.1%
Immunofixation
Free kappa light chains
24-hour-urine protein
310.5 mg/24 hour
0–150
24-hours-urine creatinine
0.7 g/24 hour
0.74–1.57
24-hour-urine volume
1150 cc
24-hour-urine creatinine
0.5 g/24 hour
0.74–1.57
24-hour-urine volume
900 mL (repeat test)
24-hour-urine calcium
239 mg/24 hour
100–300
Serum protein electrophoresis
Albumin
3.3 g/dL
3.1–5.0
Alpha 1
0.3 g/dL
0.2–0.5
Alpha2
0.7 g/dL
0.5–1.1
Beta
0.6 g/dL
0.6–1.1
Gamma
1.5 g/dL
0.7–1.7
Albumin/globulin
1.0
M spike
1.09 g/dL
Total protein
6.5 g/dL
6.4–8.3
Immunofixation
Monoclonal paraprotein of class IgG kappa
CD56 NK cells
63%
3–35
CD 138 marker
26%
Lambda B-cell marker
1%
1–7
Kappa B-cell marker
73%
2–14%
CD45 LCA
98%
92–100
CD38 Marker
26%
1–17
Pathology. Normal female bone marrow karyotype. No clonal, structural, or numerical chromosome abnormalities identified. FISH analysis indicates normal hybridization signals with MM probe panel. This excludes majority of chromosome rearrangements known to be associated with MM.
Surgical Pathology. Mildly hyper cellular bone marrow with plasmacytosis consistent with MM.
Leukemia/lymphoma panel. Bone marrow aspirate shows 30–40% plasma cells with kappa light chain restrictions. (plasma cell dyscrasia).
Peripheral Smear. Lymphocytes with foamy cytoplasm, no rouleaux formation, adequate polys with occasional platelet clumps.
