A case of IgA multiple myeloma: Nutritional perspective in diagnostic testing |
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| Authors: | J I Anetor F I Ajose T S Akingbola |
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| Institution: | (1) Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria;(2) Medical Centre International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria;(3) Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria |
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| Abstract: | A 64-year-old security guard and longstanding known hypertensive presented with hypertensive heart disease (HHD), weight loss,
an enlarged prostate, and a spontaneously fractured rib. Malignancy of the prostate with possible metastases to the ribs was
strongly suspected. Biochemical profiling revealed a paraprotein. Other biochemical and hematological correlates that were
on hand before serum protein electrophoresis were rather atypical. Paraprotein studies by immunofixation revealed IgA myelomatosis.
Unlike previous reports from Caucasians there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC,
cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine
level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory
picture.
The need to appreciate the influence of nutritional status on the laboratory (especially biochemical) features of a disease
and thus interpretation of diagnostic tests appears of exceptional current importance, given the widening gap in socioeconomic
status and the level of poverty between the resource poor and developed countries from which the classical, clinical and laboratory
features of most diseases were first described.
This case report reminds of the need not only to recognize theoretically the impact of nutritional status on the laboratory
characteristics of a disease but of the practical application of the nutritional perspective in the interpretation of diagnostic
investigations, especially in nutritionally disadvantaged communities. |
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| Keywords: | Multiple Myeloma Nutritional Status Protein electrophoresis Malignancy Immunofixation Resource Poor Communities |
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