Table 1: Diagnostic tests.
At Diagnosis
(with local laboratory references) |
|
Complete
Blood Count |
Hemoglobin 8.6 g/dL (12-16),
Leukocytes 13 × 103/μL (4-11),
Platelets 407 × 103/μL (150-400). |
Renal
Function and Electrolytes |
Creatinine
0.8 mg/dL (0.6-1.1); Urea 50 mg/dL
(21-43); Na+ 126 mEq/L (136-145); K+
4.4 mEq/L (3.4-5.1); PO43- 3.4
mg/dL (2.3-4.7), Mg2+ 1.65 mg/dL (1.6-2.6), ionized Ca2+ 1.16 mmol/L (1.15-1.35). |
Muscle
and Cardiac Markers |
Troponin
0.031 ng/mL (< 0.032); Myoglobin 165.1 ng/mL (< 146.9); CK 18 U/L (29-168); BNP 1833.7 pg/mL (< 100). |
Hepatic
Enzymes and Coagulation |
GGT
25 U/L (9-36); ALP 82 U/L (40-150); AST 24 U/L (5-34); ALT 9 U/L (< 55);
Total Bilirubin 0.6 mg/dL (0.2-1.2); INR 1.1; aPTT 31.2 secs (30.2); PT 11.6 secs (11.7). |
Albumin
and Proteins |
Albumin
2.2 g/dL (3.4-4.8 g/dL), serum and urinary
monoclonal protein IgA/κ; κ/λ 4.15 (1.17-2.93); Serum IgG 543 mg/dL (552-1631); IgA
102 mg/dL (69-517); IgM
34 mg/dL (33-293); C3 110 mg/dL
(83-193); C4 24.5 mg/dL (15-57). Nephrotic proteinuria 5.5 g/day without albuminuria. |
Other |
β2-microglobulin
12 9 mg/L (< 4), LDH 219 U/L (125-220), CRP 65 mg/L (< 5 mg/L), ESR 52
mm/1st h (0-30), Ferritin 744.9 ng/mL (4.63-204.0),
B12 Vitamin 430 pg/mL (189-883), Folic Acid 1.60 ng/mL (2.34-18.99). |
ECG
and Echocardiogram |
ECG:
sinus rhythm, right bundle branch block, low voltage of QRS complexes (< 1.0
mV in all precordial leads and < 0.5 mV in all limb leads).
Echocardiogram: diastolic dysfunction; increased LV wall thickness (12 mm). |
Electromyography |
Reduced
motor amplitude in all territories studied, with signs of active denervation;
no sensitive changes. |
Skeletal
Xray |
No
evidence of lytic lesions or other fractures. |
Bone
Marrow Aspirate |
Hypocellular bone marrow with 14% plasmocytes,
of which 97% were abnormal. |
Skin
Biopsy |
Chest
wall (where it appeared more thickened):positive for cutaneous amyloidosis
(apple-green birefringence with Congo red staining under polarized light) in
the context of MM. |
Other |
Angio CT: no evidence of pulmonary embolism or organomegalies, apparent thickening of the chest wall;
Bronchoscopy: no airway obstruction; Cerebral and cervical MRI: within
normal; Spirometry: restrictive disease; Lumbar
puncture: no cells, gluco or proteinorachia. |
ALP: Alkaline phosphatase, ALT: Alanine
aminotransferase, APTT: Activated partial thromboplastin
time, ASP: Aspartate aminotransferase, BNP: Brain natriuretic peptide, CRP:
C-reactive protein, CK: Creatinine kinase, ECG: Electrocardiogram, ERS: Erytrhocyte sedimentation rate, GGT: Gamma-glutamyltranspeptidase, Ig:
Immunoglobulin, INR: International normalized ratio, LV: Left ventricular, MM:
Multiple myeloma, PT: Prothrombin time, MRI: Magnetic
resonance