A word on blood films:

Iron deficient Anemia:
On the blood film you would expect hypochromic micorcytosis, pencil forms, target cells

Multiple Myeloma:

characterized by proliferation of the plasma cell producing a monoclonal immunoglobulin
blood film may demonstrate rouleaux (stacked coins)

Diagnosis: must meet 3 criteria

• monoclonal spike (M-protein) in serum or urine (although 30g/L often quoted that quantity is not met in >40% of patients and 3% of multiple myeloma is actually ‘non-seretory’


• >10% clonal bone marrow plasma cells


• presence of tissue or organ consequences “CRAB” – hyperCalcemia, Renal failure, Anemia and/ or lytic Bone lesions.

Unanswered Question of neurological symtpoms in multiple myeloma…..hyperviscosity is a syndrome of increased blood viscosity classically caused by immunoglobulins leading to impairment of the microcirculation with CNS effects including somnolence, headache, vertigo, nystagmus, hearing loss, visual impairment. Although generally described in assocaition with the IgM paraprotein of Waldenstroms, it has been reported in multiple myeloma (when abn monomers ig IgG, IgA or kappa light chains are produced.

Altered sensorium is an indication for immediate plasma exchange. In general you would like to demonstrate a high vicosisty prior to acting to differentiate the neruological changes from those of CNS myeloma etc...