🔍 Unusual case: perfect blood and urine tests, but… myeloma!
A 40-year-old patient presented with shooting lower back pain, but general blood and urine tests showed practically normal results:
🩸 CBC: hemoglobin 138 g/L, leukocytes 6.55 ×10⁹/L, platelets 203 ×10⁹/L.
Leukocyte differential (automated): Immature granulocytes (IG): 0.30% Neutrophils: 66.7% Lymphocytes: 25.2% Monocytes: 6.3% Eosinophils: 1.5% Basophils: 0.3%
📊 The differential is within normal limits, with no signs of significant inflammation or infection. Immature granulocytes (IG) in minimal quantities may indicate slight activation of hematopoiesis.
✅ Urinalysis: protein, glucose, erythrocytes, and leukocytes — absent.
However, biochemistry was surprising: ⚠ Total protein — 95 g/L (normal up to 83 g/L). ⚠ Protein electrophoresis: M-gradient (a sign of monoclonal gammopathy) - image №7.
🦴 Plasma cells in bone marrow — 91%.
💀 MRI confirmed: 🔹 Pathological fracture of L5 vertebra. 🔹 Lesions in Th12, L1, sacrum, pelvic bones.
📸 IMAGES: Photos 1-4: Bone marrow — dominance of plasma cells. Photos 5,6: Peripheral blood — rare plasma cell and reactive lymphocyte.
Conclusion: even with “perfect” CBC and urinalysis results, it is important not to forget to order a biochemical blood test.
🙏 Clinical case kindly provided by laboratory physician Yulia Kaliberda, Ekaterinburg.
