Lymphoproliferative Disorders: Plasma Cell DyscrasiasGroup members:Lonneice Bernard, Felicia Reeves and Sandeano WrightQuestions 1. Comment on the RBC indicesMCV 102fL - IncreasedMCH- 32pg IncreasedMCHC- 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 = 3.2109/L 10011=2.9109/LBii. State 4 hematological disorders that can present with similar RBC indices.The four haematological disorders are:Megaloblastic anaemiaParoxysmal Nocturnal Hemoglobinuria (PNH)Aplastic anaemiaMultiple Myeloma

C. State 5 hematological disorders that present with similar blood cell counts with this patient. The five haematological disorders are: Megaloblastic anaemiaPNHAplastic anaemiaMyelodysplastic SyndromeMultiple MyelomaDi 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 ValuesRelative Neutrophilia , Relative Lymphocytopenia, Monocyte- Normal

Absolute valuesANC- 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-Normal3. 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 MyelomaSerum 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 MacroglobulinemiaMonoclonal Gannapathy of Undetermined Significance (MGUS)Plasma Cell Leukemia

CBC Profile Presence of AnaemiaRBC can be normal or there is presence of a mild anaemiaPresence of leukocytosis with Bicytopenia

Plasma Cell10% Plasma cells seen in Bone MarrowBone marrow is infiltrated with lymphoid and plasmacytoid cellsIgM Monoclonal gammopathy10% Plasma cells seen in Bone Marrow 20% Plasma cells seen in peripheral blood thats composed of all the leukocytes

PresentationAsymptomatic, 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.

DiagnosisSerum Protein Electrophoresis - Monoclonal spike in the M regionSerum Protein Electrophoresis small M-spike in patient sampleUrine Protein - 200mg/24hours, IgG305g/dL and IgA2.0g/dLImmunophenotyping, shows CD 20 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.