Haematology
Case 20: A Patient with Increasing Nausea
CASE
A 45‐year‐old man presents to his GP with a 3‐week history of increasing nausea. Over the last 2 days he has developed a sharp pain in his chest which is worse on lying flat and relieved on sitting forward. He has no other past medical or drug history. On examination, he looks unwell and auscultation of his precordium revealed a rub. Respiratory and abdominal examination were normal.
Blood test results showed:
Hb 9.6 g/dL MCV 99 fL WBC 3.3 × 109/L Platelets 140 × 109/L Na 138 mmol/L K 7.3 mmol/L Corrected Ca 2.5 mmol/L Urea 35.5 mmol/L Creatinine 890 µmol/L Albumin 38 g/L Bilirubin 9 µmol/L ALT 23 U/L ALP 135 U/L
He was admitted to the local renal unit for urgent dialysis. Whilst on the unit, the following results came back:
Serum electrophoresis: immune paresis
No monoclonal band
Skeletal survey: multiple lytic lesions skull and ribs
QUESTION 1
Your score this session: 0 of 0
What is the most likely cause of his electrophoresis result?