所有症状性多发性骨髓瘤(MM)中不到2%具有免疫球蛋白D(IgD)作为单克隆蛋白。双态丙种球蛋白病要罕见得多。在诊断的时候,疾病往往处于晚期,包括肾衰竭,贫血,高钙血症和溶解性骨病变。由于骨髓瘤本身的稀有性,而且由于抗IgD抗血清不用于常规实践,文献中只有少数IgDMM的报道。该病例报告描述了患有IgDλMM的贫血和肾衰竭的患者。贫血,肾功能衰竭,我们的IgDlambdaMM患者的骨活检中>80%的浆细胞符合国际骨髓瘤工作组的MM诊断标准。患者的临床过程与其他IgDMM患者相似。血清蛋白免疫固定(s-IFE)的最终结果显示IgDλ和游离λ单克隆条带。为了防止误诊,有必要使用抗IgD和抗IgE抗血清,IgM,IgG,κ和λ抗血清显示κ或λ单克隆带,重链中没有单克隆带。
Less than 2% of all symptomatic multiple myeloma (MM) has immunoglobulin D (IgD) as monoclonal protein. Biclonal gammopathy is much rarer. At the time of diagnosis, disease is often in advanced stage, including renal failure, anemia, hypercalcemia and lytic bone lesions. Due to the rarity of myeloma itself, but also due to the fact that anti-IgD antisera is not used in routine practice, there are only a few reports of IgD MM described in the literature. This case report describes a patient with IgD lambda MM with anemia and renal failure. Anemia, renal failure, and > 80 percent plasma cells in bone biopsy in our patient with IgD lambda MM meets International Myeloma Working Group criteria for diagnosis of MM. The patient clinical course was similar to other patients with IgD MM. The final result of serum protein immunofixation (s-IFE) showed IgD lambda and free lambda monoclonal bands. To prevent misdiagnosis, it is necessary to use anti-IgD and anti-IgE antisera whenever the serum protein immunofixation with IgA, IgM, IgG, kappa and lambda antiserums shows a kappa or lambda monoclonal band without monoclonal band in heavy chain.