A Microscopic Mystery

Look at blood smeared across a slide under a microscope, and you see a mystery revealed.

The ruby-colored, vital, fluid of life we call blood is made of lots of stuff. There’s the liquid plasma that moves cells and protein; the red cells that bring oxygen around the body; the platelets that stop bleeding; and the different kinds of white cells that fight infection in a wide variety of ways. More about all that at another time!

Today, we’re talking about one specific type of white cell called the plasma cell, which destroys invading bacteria and other infections by making antibodies. This is a protein, egg white-like poison, which surrounds and kills unrecognized foreign intruders. Our story begins with this antibody-making plasma white cell.

Mr. M. was in his 70s and having back pain — not too unusual in his age group. But his pain was intense and seemed to involve his ribs. Mr. M. also had been feeling extremely tired lately. X-rays showed punched-out areas in the bone of ribs and spine. The blood test found elevated levels of protein and calcium, and with evidence for kidney problems and anemia. These findings suggested the possible diagnosis of multiple myeloma, a plasma cell type of white cell malignancy — or leukemia.

To confirm this diagnosis, we analyzed the blood specifically looking at the protein antibodies. We found large amounts of one single type of so-called “monoclonal” protein rather than the broad variety we usually see. With multiple myeloma, large quantities of this single type of dysfunctional antibody protein are made by plasma cells gone wild. In this case, too much protein was starting to plug up and destroy Mr. M.’s kidneys.

Also, we were concerned about his elevated calcium level, a result of bone invasion by these sick plasma cells. The high calcium was causing him to be tired and weak. In addition, we found too few red cells (anemia) because the malignant cells were pushing out the red cell-making system from his bone marrow. This resulted in even more weakness.

Multiple myeloma is the second most common blood-borne malignancy behind non-Hodgkin’s lymphoma, making up 1 percent of all cancers. It is good to know that medical tools to treat this leukemia-type illness are greatly improving because of scientific research. The treatment brought relief to Mr. M.

Look at blood smeared across a slide under a microscope, and you see a mystery revealed.


By Dr. Richard Holm

Internal Medicine Physician at Avera Brookings Medical Clinic

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