The patient was slightly anemic and had protein in their urine. Also, the albumin level was within range even though the total protein was elevated, indicating that another protein accounted for the elevation. Increased calcium indicated possible bone involvement, and a slightly elevated creatinine indicated potential kidney problems. Also of particular note were the plasma cells and rouleaux seen in the peripheral blood smear.
A plasma cell dyscrasia was suspected based on these results and the patient's symptoms. A serum protein electrophoresis and bone marrow biopsy were ordered.
To the right is a serum protein electrophoresis similar to the patient's test. It is compared to a normal or reference electrophoresis. The patient has a pronounced elevation in the gamma portion of the protein. The gamma portion contains immunoglobulins (also known as gammaglobulin). This spike reflects a monoclonal protein (known as M protein).
Based on the above results and a bone marrow smear showing approximately 25% plasma cells occurring as sheets of plasma cells (see image on bottom of page), a diagnosis of Multiple Myeloma was made.
