Multiple Myeloma Case Study

Diagnosis The 43-year old woman’s signs, symptoms and clinical tests lead to the diagnosis of multiple myeloma (MM). MM is classified as a malignant bone marrow neoplasia of a plasma cell, an activated B lymphocyte of hematopoietic stem cell linage. These monoclonal plasma cell secrete paraprotein, a protein found in the blood because of cancer or disease. In this case the plasma cell are secreting immunoglobin G (IgG) and free light chains. This can be detected via protein electrophoresis. These neoplasia’s are focused within the bone marrow however can diffuse throughout the bone (Baur-Melnyk, Buhmann, Dürr, & Reiser, 2005).
Initial Signs and Symptoms Signs and symptoms are classified differently. Symptoms are objective and described by the patient
This case of shows 1585mg/24hr, nine times higher than the referenced normal value of approximately 167 mg/24h. Creatinine a nitrogenous organic base that is used to supply energy to cells, is increased at 1.9mg/dL over the 0.5-1.1mg/dL normal value. Just as creatinine, calcium is also high at 12.4 mg/dL when compared to the normal value of 8.5-10.2 mg/dL. All three of these test results lead to the diagnosis, kidney dysfunction. Kidney dysfunction occurs because the glomerulus within the kidney responsible for the ultrafiltration of blood, excrete the large numbers of monoclonal antibodies into the proximal tubules which results in the proteinuria. However, such large volumes of antibodies within these tubules detrimentally affect the proximal tubules to catabolize proteins. Antibodies can bind to Tamm-Horsfall mucoprotein to form casts in the distal convoluted tubule. This can continue to manifest as larger casts resulting in a blockage. This obstruction leads to a decrease in kidney function thus, increasing serum creatinine and calcium. MM’s effect on the kidneys has a continual detrimental effect (Faiman, Mangan, Spong, & Tariman,