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Medicine

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Hematology

Question
22 out of 29
 

A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. Her investigations show hemoglobin of7.3 gm/dl, serum calcium 12.6 mg/dl, phosphate 2.5mgldl, alkaline phosphates 100 u/l, serum albumin 3 gm/dl, globulin 7.1 gm/dl, and urea 178 mg/dl. What is the most likely diagnosis? (AI 09, AIIMS Nov 11, Repeat AIIMS Nov. 2010)



A Lung cancer
B Disseminated tuberculosis

C Multiple myeloma
D Osteoporosis

Ans. C

Multiple myeloma

Poor prognostic factors in multiple myeloma

Stage related factors

Independent factors

Stage III disease: High Tumor Burden

1. Hb < 8,5 g/dl

2. Hypercalcemia (Ca > 12 mg/dl)

3. Advanced Lytic bone lesions

4. High M component production

a. IgG> 7g1dl

b. IgA> 5g1dl

c. Urine light chains> 12g/24 hrs

Sub classification based on serum creatinine levels

Serum creatinine> 2 mg/dl

1. β2 microglobulin (single most important factor)

2. Serum albumin

3. LDH

4. labeling index (%age of cells undergoing mitosis)

5. CRP or IL6

6. Hepatocyte growth factor, TGF (β) or syndecans - 1

7. Plasmo blastic morphology

Genetic Abnormalities

a. Hyperploidy

b. Chromosome 13 deletion (and chromosome 17p

c. deletion)

d. t(4; 14), t(l4; 16), t(11; 4) translocation

e. d. RAS & P53 mutations.

Hematology Flashcard List

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