Medical Emergencies · patient case question
Bone marrow examination in multiple myeloma characteristically shows an excess of which cell?
Patient case: Emergencies and risk assessment
demo: Assorted patients
chief: Several patients present with findings that alter the safety of planned dental care.
history: One patient with well-controlled asthma using albuterol reports her last attack was ten months ago. Another feels faint on being returned to upright. A third has type 1 diabetes and presents unwell with deep rapid breathing and a fruity breath odour.
meds: Albuterol; insulin; various.
findings: Not applicable.
Show answer and explanation
Correct answer: D. Plasma cells
- A. A lymphocytic marrow infiltrate suggests chronic lymphocytic leukaemia or lymphoma, not myeloma.
- B. Neutrophilia indicates acute bacterial infection or inflammation. Myeloma patients are more often neutropenic from marrow crowding.
- C. Eosinophilia points to parasitic infection, allergy or Langerhans cell histiocytosis.
- D. Correct. Multiple myeloma is a clonal proliferation of plasma cells, and the diagnostic marrow threshold is 10 percent or more clonal plasma cells. They secrete a monoclonal immunoglobulin producing the serum M spike and Bence Jones light chains in urine. Jaw involvement gives punched-out radiolucencies, and the CRAB features are hypercalcaemia, renal impairment, anaemia and bone lesions.
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