Ramesh 60 years, presents with generalized bone pain. On examination there is elevated ESR of 100 mm, serum globulin 7, lytic lesions in the skull, serum creatinine of 3.5 mg/dL and serum calcium of 11 mg/dL. What is the most likely diagnosis :

Answer is B (Multiple myeloma) This is a 60 year patient presenting with generalized bone pain and lytic lesion in skull with blood parameters indicating a markedly raised ESR, Hrnercalcetnia, Hyperglobulinemia and raised serum creatinine. All these suggest a diagnosis of multiple myeloma. Patient Normal Interpretation & inference Age 60 years - 60 years ESR 100 < 15 (male) Markedly increased Serum globulin 7 2.5 to 3.5 Increased Serum creatinine 3.5 < 1.5 mg/dl Increased: Renal failure Serum calcium 11.0 9 mg/dl Increased hypercalcemia Distinguishing features between W. Macroglobulinemia from multiple mveloma Does not cause lytic bone lesions Does not cause hypercalcemia* serum calcium is usually not elevated* Serum 'M' component is IgM - IgM being large in size undergoes Less renal excretion - Renal disease is not common Q - Serum creatinine is usually not elevated. - Hepatomegaly, splenomegaly and lymphadenopathy are common unlike in multiple myeloma where they are uncommon. - Symptoms due to hyperviscocity are more prominent as compared to those in multiple myeloma - Epistaxis visual disturbance and neurological symptoms are more common. - Rouleaux formation and positive Coombs test are more common.