❗Clinical case. Flaming plasma cells without M-gradient, with severe anemia and moderate thrombocytopenia.
✅ A 65-year-old male presented with complaints of easy fatigability and pallor for the past month. On examination, mild splenomegaly 3 cm below the left costal margin with axillary lymphadenopathy was noted.
🩸 Complete blood count showed severe anemia (50 g/L) with 0.3% corrected reticulocyte count, normal leukocyte count, and moderate thrombocytopenia (62 x 10^9/L).
✅ Direct Coombs test for monospecific IgG and C3d was negative. Peripheral blood smear showed moderate anisopoikilocytosis without rouleaux formation.
⚠ Serum protein electrophoresis showed no monoclonal band; serum total protein (68.6 g/L) and albumin (44.5 g/L) levels were within normal limits.
✅ Renal and liver function tests and serum calcium results were normal, except for mild unconjugated hyperbilirubinemia. Urine analysis was normal, with no Bence-Jones protein.
🦴 Bone marrow aspirate revealed numerous plasma cells of varying sizes, including large flaming cells filled with immunoglobulins. Numerous binucleated plasma cells and large cytoplasmic inclusions were noted (image 1,2 below). Flow cytometry of plasma cells showed positivity for CD43, CD20, CD200, and kappa restriction. Plasma cells showed cytoplasmic positivity for CD138. The patient did not opt for therapy.
👉 Source: imagebank.hematology
