Dr. Goswami Parth Rajendragiri
Pathology
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Patient's Query
Hi doctor,
My father is a 70-year-old male with BPH and well-controlled type-2 diabetes. He has been fatigued for six weeks. He was found three weeks ago to have mild anemia (Hb-12 gm/dL) and macrocytosis with a mildly low Vitamin B12. He started Vitamin B12 but had a slow progression of fatigue and had further testing yesterday. This showed Hb at 10.5 gm/dL, Plt 108,000 platelets/µL. Differential showed a single metamyelocyte, no blasts. He had slightly decreased renal function (I believe Cr 1.3 mg/dL, GFR around 50 mL/min/1.73 m2). His total protein was 14.8 g/dL with albumin 1.9 g/dL. Aside from fatigue, he had mild hypotension, resolving with discontinuation of tablet Tamsulosin and tablet Lisinopril. I am a family physician, and he was previously an ICU RN. Protein electrophoresis is pending, and he has a referral to a hematologist. I believe he is likely to have multiple myeloma. I have never seen a globulin level approaching these numbers. Are there potential immediate complications like hypercoagulability with such an elevated globulin level, and would the risk of those complications warrant emergency treatment?
Hello,
Welcome to icliniq.com.
Following is my opinion for your asked question.
We cannot say multiple myeloma conclusively just now. Impaired kidney function also can cause anemia, fatigue, and low platelet count.
Diabetes could have produced such renal dysfunction. However, serum immunofixation electrophoresis will rule out plasma cell dyscrasia if present.
You can revert along with the report once done. If there is no sign of a clot in the body, then do not worry.
You can check the D-dimer level to check for the micro clot.
Meanwhile, I suggest tablet Aspirin 75 or 150 mg to prevent clots.
Advise him to walk daily for few minutes. Geriatric old age and kidney dysfunction-induced anemia could occur because of fatigue.
An increase in globulin does not warrant immediate clot formation. Inflammation can raise it, so wait for immunofixation electrophoresis.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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Pathology
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