Middle aged man with bone and body pain with:

1.

C – Hypercalcaemia

R – Renal Failure

A – Anaemia

B – Bone pain

Anaemia – Normocytic

Low Platelets

High WCC – ?sepsis, other

Failure of 2 cell lines

High bilirubin, mixed obstructive/ hepatitic picture (relatively high GGT – ?alcohol, haemolysis)

Normal INR – ?normal synthetic function

Hyponatraemia – liver disease, other

Low HCO3 – metabolic acidosis – need Chloride to check Anion gap

Renal failure with normal potassium

Corrected Ca – 2.6

2. Multiple Myeloma

3. Assessment

History – bone pain, joint pain, non specific symptoms

Examination – none specific

Lab Investigation:

– FBC and blood film

– UEC – renal failure

-LFT

– LDH

– Ca, Mg, PO4, B2 macroglobulin

– Protein electrophoresis and immunofixation

– Serum free light chain analysis

– 24 hr urine protein and electrophoresis

– bone marrow aspirate and trephine

– viral serology

– TTE or TOE

 

Radiology:

– skeletal survey