Year: 2021
Type: article
Abstract: A 72-year-old man presented with vertebral compression fractures and fatigue. His full blood count showed only mild anaemia (Hb 105 g/l). Biochemical tests showed elevated creatinine (218 µmol/l), normal calcium (2·5 mmol/l), and a small monoclonal spike (0·66 g/l) on serum protein electrophoresis. Lambda free light chains were markedly elevated (1350 mg/l, kappa:lambda ratio 0·008). Bone marrow examination revealed 25% medium to large dysmorphic plasma cells with a low nuclear-cytoplasmic ratio, irregular nuclei, slightly decondensed chromatin and basophilic cytoplasm (Images, May-Grünwald-Giemsa, ×100 objective) sometimes containing red blood cells (black arrows), platelets (red arrows) or neutrophils (green arrow) within cytoplasmic vacuoles. Flow cytometric immunophenotyping showed CD38-positive, CD138-positive plasma cells, which had heterogeneous expression of CD117 and low or no expression of CD19, CD45, CD27 and CD81. Cytogenetic analysis of sorted plasma cells showed t(14;16)(q32;q23); IGH/MAF. These results were indicative of multiple myeloma with haemophagocytosis by neoplastic plasma cells. Haemophagocytosis by malignant cells (in particular erythrophagocytosis) is a well-known phenomenon in acute myelomonocytic or monocytic leukaemia with t(8;16)(p11.2;p13.3). However, it is extremely rare in multiple myeloma. This unusual observation should not be confused with a haemophagocytic syndrome, a life-threatening emergency that may develop in the course of malignancies.
Source: British Journal of Haematology
DOI: 10.1111/bjh.17299
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3128948665