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A 79-year-old Caucasian man presents with a chief complaint of back pain. Hemoglo bin is 9.7 g/dl. leukocyte count 7.600/Jll. and platelet count 21 LJ,OOO/fll. BUN is 26 mg/dl. creatinine 2.1 mg/dl. total protein 9.0 g/dl. albumin 3.1 g/dl. and calcium 10.9 mg/dl. The images below show the bone marrow aspirate and a skull film from the skeletal survey.
Which of the following lab tests is necessary to complete the staging of the patient according to the International Staging System (ISS)?
- Serum M-protein level
- Sedimentation rate
- Assay for urine light chains
- Beta-2 microglobulin
- Quantitative free light chain assay
Medicine
D. The bone marrow aspirate shows increased cells with blue cytoplasm, a perinuclear hof, and an eccentric nucleus with clumped chromatin, characteristic of plasma cells. Skull radiograph depicts the punched out lesions typical of multiple myeloma (MM). The ISS uses albumin and beta-2 microglobulin levels to stratify patients with MM into one of three levels.
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