TY - JOUR
T1 - Triclonal Gammopathy in Multiple Myeloma with Bleeding Diathesis
T2 - A Case Report
AU - Samruddhi, H. R.
AU - Srikantiah, Rukmini Mysore
AU - Harish, Sindhu
AU - Balanthimogru, Prashantha
AU - Rai, Sharada
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Association of Clinical Biochemists of India 2024.
PY - 2024
Y1 - 2024
N2 - Introduction: Gammopathies have clinical and diagnostic significance for lymphoproliferative disorders and plasma cell dyscrasias such as multiple myeloma which is distinguished by the malignant growth of a plasma cell clone that generates monoclonal immunoglobulin. A 70-year old patient was evaluated for recurrent epistaxis and bleeding per rectum along with severe anemia in the past two months. A general physical examination revealed pallor. Blood tests showed pancytopenia. Methods: Hemogram, biochemical investigations, SPE, Serum-free light chain assay, Immunofixation electrophoresis, Bone marrow aspiration cytology & Immunophenotyping, and flow cytometry. Results: Immunofixation electrophoresis showed triclonal gammopathy IgM Kappa, IgG Kappa, and IgA Lambda and SPE quantitation of M band—5.6 gm%. Serum kappa and lambda light chains were 204 mg/L and 11.22 mg/L respectively, and the kappa/lambda ratio-18.18. Bone marrow aspiration cytology showed extensive rouleaux formation of RBCs, scattered myeloid and erythroid cells, and a few abnormal plasmacytoid cells accounting for approximately 4% of all nucleated cells. The flow cytometry revealed clotted aspirate and the smear showed occasional scattered plasma cells. The bone marrow- immunophenotyping showed CD38/CD138 bright plasma cells (4.7%). The plasma cells showed co-expression of CD81, and CD27 and were dim for CD45 with variable CD56 expression. A severely altered A/G ratio was observed. Conclusion: In plasma cell dyscrasias and lymphoproliferative diseases, monoclonal gammopathies are often observed, while the biclonal variety is less frequent. However, tri clonal gammopathy having a combination of IgM Kappa, IgG Kappa, and IgA Lambda is extremely rare and their clinical significance is unknown.
AB - Introduction: Gammopathies have clinical and diagnostic significance for lymphoproliferative disorders and plasma cell dyscrasias such as multiple myeloma which is distinguished by the malignant growth of a plasma cell clone that generates monoclonal immunoglobulin. A 70-year old patient was evaluated for recurrent epistaxis and bleeding per rectum along with severe anemia in the past two months. A general physical examination revealed pallor. Blood tests showed pancytopenia. Methods: Hemogram, biochemical investigations, SPE, Serum-free light chain assay, Immunofixation electrophoresis, Bone marrow aspiration cytology & Immunophenotyping, and flow cytometry. Results: Immunofixation electrophoresis showed triclonal gammopathy IgM Kappa, IgG Kappa, and IgA Lambda and SPE quantitation of M band—5.6 gm%. Serum kappa and lambda light chains were 204 mg/L and 11.22 mg/L respectively, and the kappa/lambda ratio-18.18. Bone marrow aspiration cytology showed extensive rouleaux formation of RBCs, scattered myeloid and erythroid cells, and a few abnormal plasmacytoid cells accounting for approximately 4% of all nucleated cells. The flow cytometry revealed clotted aspirate and the smear showed occasional scattered plasma cells. The bone marrow- immunophenotyping showed CD38/CD138 bright plasma cells (4.7%). The plasma cells showed co-expression of CD81, and CD27 and were dim for CD45 with variable CD56 expression. A severely altered A/G ratio was observed. Conclusion: In plasma cell dyscrasias and lymphoproliferative diseases, monoclonal gammopathies are often observed, while the biclonal variety is less frequent. However, tri clonal gammopathy having a combination of IgM Kappa, IgG Kappa, and IgA Lambda is extremely rare and their clinical significance is unknown.
UR - https://www.scopus.com/pages/publications/85190852861
UR - https://www.scopus.com/pages/publications/85190852861#tab=citedBy
U2 - 10.1007/s12291-024-01224-w
DO - 10.1007/s12291-024-01224-w
M3 - Article
AN - SCOPUS:85190852861
SN - 0970-1915
JO - Indian Journal of Clinical Biochemistry
JF - Indian Journal of Clinical Biochemistry
ER -