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Myeloma. Clinical case review.

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by

Justina Traceviciute

on 29 October 2013

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Transcript of Myeloma. Clinical case review.

Clinical case review by Justina Traceviciute
Progression
09.26
Patient goes to Haematology Day Center for Myeloma CyBorDex treatment protocol (4x)
10.10
Oedema progress! Nephrotic syndrome! Hypotension --> Syncope.
Gets treatment with Furozemid, Hydrochlortiazid, Spironolacton.
Happy End?!
Patient is stable.
Less weakness/ Patient feels better.
Oedema is present, but less than before.
Patient
He continues treatment for myeloma according to CyBorDex protocol at Haematology Day Care Center.
For the future!
Male, 67 y.
Anamnesis vitae
II type Diabetes (use Metforal)
Constant hypotension
2x heart microinfarcts
In 2010 - 2x coronaroangiography
No joundice, TBC, OP known
Allergic to ampicilin, biseptol, citramon (aspirin + paracetamol)
Retired
Complains
RECOMMENDATIONS!!!
Treating
Hypercholesterolemia: Fluvostatinum

Hyperuricemia: Allopurinol
Prophylaxis
Thrombosis: Fraxiparinum and Protifar [protein corrections]
Infection: Dapson
Oedema: Spironolacton, Hydrochlortiazidum, Torazemidum
Sweet dreams
Lorazepam
Control
Family doctor
Haematologist
Nephrologist
Thank You!
“There is no exercise better for the heart than reaching down and lifting people up.”
John Holmes
Swollen legs for 2 month
short breath during minimal activity
low blood pressure
Progressive weakness
Examination
Blood test (2013.08.16)
Total protein 45,9 g/l
M gradient 9,3 %
Ig A lambda monoclone
Ig kappa (free) 5,88 mg/l
Ig lambda (free) 60 mg/l
Kappa/lambda ratio 0,098 (N 0,26-1,65)
B2 microglobulin 3,06 mg/l
Urine
Total protein 15,4 g/l,
Ig kappa (free) 18,2 mg/l,
Ig lambda (free) 35,5 mg/l
Bone X ray
No destructive lesions
Biopsies
TREPANOBIOPSY:
plasmocytes hyperplasia >10% with aberrant immunophenotype: CD138+; IG lambda+ > IG kappa; CYCLIND1+; IGA+; IGG(-); CD56/CD117/CD20(-) --> possible myeloma?!
KIDNEY BIOPSY:
Kidney amiloidosis. Early stage. AL type.
Nephrologist's consultation
Cholesterol (mmol/l) 16,93 !!!
Creatinine (mcmol/l) 76 :)
Total protein (g/l) 45,9 --> 36,6
Albumin (g/l) 16,3 !!!
CRB (mg/l) 3,4
Proteinuria 4+ !!!
Nephrologist takes the patient with
At the department
Examination
Dinamics
Cardiologist's consultations
What goes next?
Patient is stable. In moderate condition. Vital signs are normal.
Decreased sounds in the lower lobes of the lungs.
Oedema in lower extremities (4+).
TP (g/l) 45,9 --> 36,6 --> 35,4 --> 36,5
Alb (g/l) 16,3 --> 16,4 --> 16,2

Chol (mmol/l) 16,9 --> 12,4
ENG (mm/h) 77 --> 52
D-dimers (mcg/l) 810
Admission day
Next day:
Heart UG --> LVH I Grade
Chest X-ray --> pleural space looks darker (fluids?)
ECG --> Low QRS voltage. LBBB (LAFB).
Full transcript