Multiple myeloma from White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions, presented by MediaLab

White Blood Cell Disorders and Platelets:: 6. Non Granulocytic White Blood Cells

Multiple myeloma

Plasma cells are uncommonly observed in the peripheral blood smear.
They are normal constituents of lymph nodes, spleen, connective tissue and bone marrow.
The presence of plasma cells in the peripheral blood is indicative of a large number of conditions mostly related to infections , immune disorders, malignancies, toxic exposures, hypersensitivity reactions and their responses.
Although mature plasma cells have a distinct appearance, they still may be confused morphologically with immature plasma cells and other cells with inclusions, reactive changes or nucleated red bloods cell with altered identities.
In the upper and lower photographs are plasma cells with features mindful of myeloma cells
The large myeloma cell in the upper photograph has an eccentric immature nucleus with a muddy chromatin pattern.
Note also clumping and stacking of the erythrocytes, bordering on rouleaux formation ,implicating an increase in plasma gamma globulin.
The plasma cell with the double nucleus in the lower photograph is particularly suggestive of myeloma.
Further studies are in order including a bone marrow examination where at least 30% of bone marrow cells should be variations of mature and immature plasma cells.
Serum electrophoresis will reveal a monoclonal globulin spike, and light chains in excess of 1.0 gm/24 hours may be seen in the urine.
The presence of lytic bone lesions is a convincing clinical clue.
With these findings in combination, a diagnosis of myeloma can be made with assurance.

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