PDF(Pubmed)
Abstract：
Serum hyperviscosity is a rare laboratory finding. Amongst several causes of serum hyperviscosity, malignant disorders are quite common. Monoclonal gammopathy is a family of disorders in which monoclonal gammopathy of unknown significance (MGUS) and smoldering myeloma are the asymptomatic variants whereas multiple myeloma is the malignant variant showing different signs and symptoms related to bone lesions, renal failure and anemia. Initially during sample preparation, pipetting of a serum sample was found to be cumbersome. This sample during routine analysis in the automated analyser flagged repeated alarms for clot detection indicating a possibility of a hyper viscous sample. Serum was subjected to fibrinogen and D- dimer test. The D-Dimer levels were found to be normal and fibrinogen levels were mildly elevated. Routine biochemistry investigations were normal except grossly reversed A/G ratio. Due to gross reversal of A/G ratio, the possibility of Multiple myeloma was entertained. Physician\'s were alerted on telephone. Serum was sent for electrophoresis which showeda M spike. Bone marrow aspirate showed 13% plasma cells. Considering the above lab results the diagnosis of monoclonal gammopathy of smoldering type was considered. The sample was traced to a 77 years old male, who presented to Medicine OPD with the chief complaints of generalised weakness for two months without any history of fever. On physical examination pallor was evident but there was no icterus, cyanosis, clubbing, lymphadenopathy or edema. On haematological evaluation patient was found to be anemic. Careful tracking of hyperviscous patient\'s serum followed up by thorough investigation led us to the final conclusion that the case mentioned is a rare case of Smoldering type of multiple myeloma.
摘要：
血清高粘度是一个罕见的实验室发现。在血清高粘度的几种原因中，恶性疾病很常见。单克隆丙种球蛋白病是一类疾病，其中意义不明的单克隆丙种球蛋白病（MGUS）和闷烧的骨髓瘤是无症状的变异，而多发性骨髓瘤是恶性变异，表现出与骨病变相关的不同体征和症状。肾功能衰竭和贫血。最初在样品制备过程中，血清样本的移液被发现是麻烦的。在自动分析仪中的常规分析期间,该样品标记用于凝块检测的重复警报,指示超粘性样品的可能性。对血清进行纤维蛋白原和D-二聚体测试。发现D-二聚体水平正常，纤维蛋白原水平轻度升高。除了A/G比严重逆转外，常规生化检查均正常。由于A/G比率的总逆转，考虑了多发性骨髓瘤的可能性。医生在电话中收到了警报。将血清送去电泳，显示M尖峰。骨髓抽吸物显示13％的浆细胞。考虑到上述实验室结果，考虑了闷烧型单克隆丙种球蛋白病的诊断。样本被追踪到一名77岁的男性，他向MedicineOPD提出了两个月的全身无力的主要投诉，没有任何发烧史。体检时脸色苍白明显，但没有黄疸，紫癜,俱乐部,淋巴结肿大或水肿。在血液学评估中，发现患者贫血。仔细跟踪高粘性患者的血清，并进行彻底的调查，使我们最终得出结论，该病例是罕见的阴燃型多发性骨髓瘤病例。
