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Medicine

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Hematology

Question
24 out of 29
 

An 80 year old asymptomatic woman was detected to have a monoclonal spike on serum electrophoresis (lgG levels 1.5 g/dl). Bone marrow revealed plasma cells of8%. The most likely diagnosis is: (AIPG 2011)



A Multiple myeloma

B Indolent myeloma

C Monoclonal gammopathy of unknown significance

D Waldenström’s macroglobulinemia

Ans. C

Monoclonal gammopathy of unknown significance (MGUS)

Other Causes Of Paraproteins

Monoclonal B gammopathy Of Uncertain Significance (MGUS)

A paraprotein present in the blood but with no other features of myeloma.

Age: Elderly Aetiology: Unknown

Clinical features

Patients are usually asymptomatic.

Investigations

1. Routine blood count and biochemistry are normal.

2. The paraprotein is usually present in a small amount with no associated immune paresis. (<3 gm%)

3. There are no lytic lesions on the bones.

4. The bone marrow may have increased plasma cells but these are usually less than 10%.

5. No Bence zone protein = Normal S.ca , no renal failure

Management

1. Usually symptomatic treatment

2. Follow up to monitor clinical symptoms and paraprotein levels

3. Other diseases which can develop in MGUS are lymphomas, amyloidosis, chronic lymphatic leukemia and solid tumors.

Prognosis

With long-term follow-up, approximately 30% of patients develop other problems; 20% develop myeloma and the remainder solid tumours.

Hematology Flashcard List

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