Haematology
Case 19: A Patient with Lower Back Pain
CASE
A 68‐year‐old woman presents to her GP with a 3‐month history of worsening lower back pain. The back pain is localized to the small of her back and has recently been waking her from sleep. Her appetite and weight are steady and she has no other symptoms. She has a history of mild hypertension for which she takes bendroflumethazide. On examination she looks well and has a normal cardiovascular, respiratory and abdominal examination.
Results of investigations are as follows:
Hb 13.4 g/dL MCV 95 fL WBC 6.7 × 109/L Platelets 175 × 109/L Na 130 mmol/L K 4.5 mmol/L Corrected Ca 2.25 mmol/L Urea 3.5 mmol/l Creatinine 75 µmol/L Bilirubin 8 µmol/L ALT 35 U/L ALP 640 U/L
Serum electrophoresis: small IgG lambda M band
No immune paresis
Paraprotein level: 6.4 g/L
Skeletal survey: no lytic lesions
Bone scan: An area of increased uptake is seen in L4 vertebra.
QUESTION 1
Your score this session: 0 of 0
Which of the following test results is most consistent with a diagnosis of myeloma?