Lymphoproliferative Disorders: Plasma Cell Dyscrasias

Group members:
Lonneice Bernard, Felicia Reeves and Sandeano Wright
Questions
1. Comment on the RBC indices
MCV 102fL - Increased
MCH- 32pg Increased
MCHC- 31g/d - NORMAL

Bi. Is the WBC count reported accurate? If not perform the necessary step to ensure accuracy for
the WBC count.
No the WBC count is not accurate because the nRBC/100 WBCs seen in peripheral blood are
greater than 10.
therefore the corrected WBC count = 3.210
9
/L 10011=2.910
9
/L
Bii. State 4 hematological disorders that can present with similar RBC indices.
The four haematological disorders are:
Megaloblastic anaemia
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Aplastic anaemia
Multiple Myeloma

C. State 5 hematological disorders that present with similar blood cell counts with this patient.
The five haematological disorders are:
Megaloblastic anaemia
PNH
Aplastic anaemia
Myelodysplastic Syndrome
Multiple Myeloma
Di In what ways are plasma cells and nRBCs similar.
Plasma cell and nRBC are both mononuclear cells and lack necleoi and decreased N:C ratio.
Dii. How would differentiate plasma cells and orthrochromatic normoblasts.
Plasma cells can be differentiated from a orthochromatic normoblast by the nucleus and
Cytoplasm. The plasma cell nucleus is eccentric and the orthochromatic normoblast nucleus is
centered, the cytoplasm of the plasma cell has an intense blue purple colour along with a
perinuclear halo and the orthochromatic normoblast has a pinkish cytoplasm.

2. Use hematological terms to describe the relative and absolute values and the entire WBC
differential.
Relative Values
Relative Neutrophilia ,
Relative Lymphocytopenia,
Monocyte- Normal


Absolute values
ANC- 82 2.9/100= 2.4 - Normal
ALC- 10 2.9/100 = 0.29 - Lymphocytopenia
AMC- 12.9/100 = 0.029 - Normal
AEC- Normal
ABC-Normal
3. Based upon all data provided, what is the next step in the diagnosis for this patient.
The next step in diagnosis for this patient is to do a bone marrow aspirate to check if
greater than or equal to 10 plasma cells are present. If this is present indicates
plasmacytoma

4. State the results expected for 2 confirmatory tests that will enable the diagnosis of the
suspected disorder.

24hr urine sample- Bence-Jones protein is present this will aid in the diagnosis of
Multiple Myeloma
Serum Protein Electrophoresis Monoclonal spike in gamma globulins.
5. State three haematological disorder from the Plasma Cell Dyscrasias category that will
require differentiation and differentiate them.
The three plasma cell dyscrasias are:
Waldenstroms Macroglobulinemia (WM)
Monoclonal Gammopathy of Undetermined Significance (MGUS)
Plasma cell Leukemia (PCL)

Waldenstroms
Macroglobulinemia
Monoclonal Gannapathy of
Undetermined Significance
(MGUS)

Plasma Cell Leukemia
CBC Profile Presence of Anaemia RBC can be normal or there is
presence of a mild anaemia
Presence of
leukocytosis with
Bicytopenia
Plasma Cell 10% Plasma cells
seen in Bone Marrow
Bone marrow is
infiltrated with
lymphoid and
plasmacytoid cells
IgM Monoclonal gammopathy
10% Plasma cells seen in
Bone Marrow
20% Plasma cells
seen in peripheral
blood thats composed
of all the leukocytes
Presentation Asymptomatic,
fatigue, weight loss,
generalized weakness.
Progressive sensory
motor peripheral
neuropathy.
Raynauds
Phenomenon,
thrombosis.
Hyperviscosity,
lymphadenopathy,
hepatosplenomegally that is
attributed to the underlying
lymphoproliferative disorder
and no lytic lesions.
Hypercalcemia,
anaemia,
Thrombocytosis, renal
impairment, lytic bone
lesions observed but
slight lower than that
which is seen in
Multiple Myeloma.
Diagnosis Serum Protein
Electrophoresis -
Serum Protein Electrophoresis
small M-spike in patient
Immunophenotyping,
shows CD 20
Monoclonal spike in
the M region
sample
Urine Protein -
200mg/24hours, IgG305g/dL
and IgA2.0g/dL
positivity and
negativity for CD56


6. Discuss the pathophysiology of Multiple Myeloma.
Inappropriate transformation of B cells into plasma cells. The agent responsible for
stimulation of B cell is not an antigen and the cells are therefore not functional. These
abnormal cells are carried to the bone marrow where homing takes place. Within the
bone marrow each abnormal plasma cell proliferates producing another colony resulting
in plasmacytoma. Overproliferation leads to the bone marrow becoming crowded causing
reduction of other normal cells leading to pancytopenia. The abnormal cells are also
released back into peripheral blood from where they migrate to extramedullary sites
causing infiltration of tissues. The abnormal plasma cells also produce incomplete
immunoglobulins that are monoclonal. There is also the production of osteoclast
activation factor causing bone destruction.
7. The ESR results for the patient is also elevated. This resulted from the large amount of
incomplete immunoglobulins being produced by the abnormal plasma cells into
circulation.