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What is A 56 year old male is being evaluated for the low back pain. No history of trauma to back is elicited. He also complains of weight loss, fatigue and recurrent sinus infection. Examination revealed focal tenderness at the T10 level. Blood workup was done which revealed Hb of 9 g/dl. RFT were deranged as well. Skull x ray was done as shown. Bone marrow biopsy and serum protein electrophoresis was planned. What is the characteristic abnormality that will be evident in the patient on peripheral blood film? and explain in detail?
Skull x ray - show punched out lesion (osteolytic lesion). Anemia, increased creatinine (deranged RFT), hypercalcemia and bone pains are classic presentation of MULTIPLE MYELOMA which is the diagnosis of above clinical scenario. The characteristic finding of multiple myeloma on PBF is rouleaux formation or stacking of RBCs like stacked coins, due to agglutination which is mediated by M protein