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血液学家/医生需警惕单克隆丙种球蛋白病中的假性高钙血症：一则病例报告的经验教训

Hematologists/Physicians Need to Be Aware of Pseudohypercalcemia in Monoclonal Gammopathy: Lessons from a Case Report.

作者信息

Mennens Svenja F B J, Van der Spek Ellen, Ruinemans-Koerts Janneke, Van Borren Marcel M G J

机构信息

Laboratory of Clinical Chemistry and Hematology Rijnstate Hospital, Arnhem, Netherlands.

Department of Clinical Chemistry DICOON BV, Arnhem, Netherlands.

出版信息

Case Rep Hematol. 2024 Aug 19;2024:8844335. doi: 10.1155/2024/8844335. eCollection 2024.

DOI:10.1155/2024/8844335
PMID:39189035
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11347025/
Abstract

We present a patient at risk of misdiagnosis with multiple myeloma due to pseudohypercalcemia. Examinations showed monoclonal protein, 50% monoclonal plasma cells in bone marrow, and hypercalcemia but no osteolytic bone lesions. Follow-up tests revealed pseudohypercalcemia, with elevated total calcium, but normal ionized calcium: a discrepancy due to calcium binding to monoclonal paraprotein (confirmed by laboratory experiments). Accordingly, the patient was diagnosed with smouldering myeloma. After 900 days, the presence of bone lesions prompted the start of treatment for myeloma. Consequently, monoclonal paraprotein levels declined and pseudohypercalcemia dissolved. Hence, ionized calcium should be measured in monoclonal gammopathies to avoid misdiagnosis.

摘要

我们报告了一名因假性高钙血症而有被误诊为多发性骨髓瘤风险的患者。检查显示存在单克隆蛋白、骨髓中50%的单克隆浆细胞以及高钙血症，但无溶骨性骨病变。后续检查发现为假性高钙血症，总钙升高，但离子钙正常：这种差异是由于钙与单克隆副蛋白结合所致（经实验室实验证实）。因此，该患者被诊断为冒烟型骨髓瘤。900天后，骨病变的出现促使开始对骨髓瘤进行治疗。结果，单克隆副蛋白水平下降，假性高钙血症消失。因此，在单克隆丙种球蛋白病中应检测离子钙以避免误诊。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/643d2bbb9021/CRIHEM2024-8844335.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/0ccde073ce3d/CRIHEM2024-8844335.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/f018908ddde7/CRIHEM2024-8844335.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/643d2bbb9021/CRIHEM2024-8844335.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/0ccde073ce3d/CRIHEM2024-8844335.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/f018908ddde7/CRIHEM2024-8844335.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c97/11347025/643d2bbb9021/CRIHEM2024-8844335.003.jpg

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本文引用的文献

1
Management of Myeloma Manifestations and Complications: The Cornerstone of Supportive Care: Recommendation of the Canadian Myeloma Research Group (formerly Myeloma Canada Research Network) Consensus Guideline Consortium.骨髓瘤表现与并发症的管理：支持性护理的基石：加拿大骨髓瘤研究小组（原加拿大骨髓瘤研究网络）共识指南联盟的建议
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Pseudohypercalcemia in Multiple Myeloma: A Case Report.
多发性骨髓瘤中的假性高钙血症：一例报告
Int J Hematol Oncol Stem Cell Res. 2017 Jul 1;11(3):246-249.
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International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.国际骨髓瘤工作组更新了多发性骨髓瘤的诊断标准。
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It is time to start ordering ionized calcium more frequently: preanalytical factors can be controlled and postanalytical data justify measurement.是时候开始更频繁地测定离子钙了：分析前因素可以得到控制，分析后数据也支持进行该测量。
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Pseudohypercalcaemia in mixed cryoglobulinaemia (IgMkappa/polyclonal IgG): a rare complication of Sjögren's syndrome.混合性冷球蛋白血症（IgMkappa/多克隆 IgG）中的假性高钙血症：干燥综合征的一种罕见并发症。
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Macroprolactin on the Advia Centaur: experience with 409 patients over a three-year period.阿维亚 Centaur 上的大泌乳素：在三年期间对 409 例患者的经验。
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Pseudo-pseudohypercalcaemia, apparent primary hyperparathyroidism and Waldenström's macroglobulinaemia.假性假性高钙血症、貌似原发性甲状旁腺功能亢进症和瓦尔登斯特伦巨球蛋白血症。
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