A 70-year-old male is seen by his physician for unintended weight loss and back pain complaints. The patient's history includes high blood pressure and high cholesterol, which are being treated. He also complains of occasional joint pain suggestive of arthritis. No other significant medical history is noted.
The physician orders a CBC, urinalysis, and routine chemistry tests. Abnormal tests include:
| Patient Result | Reference Range |
| Hemoglobin g/dL | 11.2 | 14.0–18.0 |
| White Blood Count x 103 /μL | 4.4 | 4.5–11.5 |
| Total Protein g/L | 97 | 60–80 |
| Albumin g/L | 41 | 35–52 |
| Creatinine μmol/L | 99 | 53–97 |
| Calcium mmol/L | 2.72 | 2.25–2.70 |
Other notable results from the initial screening tests included RBC rouleaux, and two cells similar to the one at the right were seen in the peripheral blood smear, which were identified as possible plasma cells. Also of note was 2+ protein in the urine.
Based on these results, further testing was indicated.
