Abstract SCOT Hickman, MD, Assistant Professor in Medicine, Washington University School of Medicine, St Louis: A 73-year-old man was referred to the hematology clinic in January 1979 for evaluation of hyperglobulinemia detected at a routine visit to his private physician. The serum total protein level at that time was 9.1 g/dL with an albumin level of 4.4 g/dL. He denied bone pain, fevers, chills, bleeding episodes, and easy bruising. Findings from a physical examination were normal. Examination of the skin showed no petechiae or rashes. No bone pain could be elicited, and he had no notable adenopathy or organomegaly. Pertinent laboratory studies disclosed the following values: hemoglobin, 14.6 g/dL; hematocrit, 43%; platelets, 200,000/cu mm; and WBCs, 7,000/cu mm, with a normal differential cell count. A serum protein electrophoresis demonstrated an M spike of 3 g/dL, found by immunoelectrophoresis to be an IgG monoclonal immunoglobulin with k light chains. Levels of IgM References 1. Kyle RA: Monoclonal gammopathy of undetermined significance: Natural history in 241 cases. Am J Med 1978;64:814-826.Crossref 2. Axelsson U, Bachmann R, Hällén J: Frequency of pathological proteins (M-components) in 6,995 sera from an adult population. Acta Med Scand 1966;179:235-247.Crossref 3. Kyle RA, Finkelstein S, Kurland LT: Incidence of monoclonal proteins in a Minnesota community with a cluster of multiple myeloma. Blood 1972;40:719-724. 4. Axelsson U: An 11-year follow-up on 64 subjects with M-components. Acta Med Scand 1977;201:173-175.Crossref 5. Ritzmann SE, Loukas D, Sakai H, et al: Idiopathic (asymptomatic) monoclonal gammopathies. Arch Intern Med 1975;135:95-106.Crossref 6. Lindström FD, Dahlström U: Multiple myeloma or benign monoclonal gammopathy?: A study of differential diagnostic criteria in 44 cases. Clin Immunol Immunopathol 1978;10:168-174.Crossref 7. Nørgaard 0: Three cases of multiple myeloma in which the preclinical asymptomatic phases persisted throughout 15 to 24 years. Br J Cancer 1971;25:417-422.Crossref 8. Fudenberg HH, Virella G: Multiple myeloma and Waldenström's macroglobulinemia: Unusual presentations. Semin Hematol 1980;17:63-79.
Archives of Internal Medicine – American Medical Association
Published: Feb 1, 1982