Post menopausal bleeding associated with extramedullary myelomatosis.
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Ery-DPG and thus the oxygen-releasing capacity of haemoglobin increases in meylomatosis and in chronic myelocytic and lymphocytic leukaemia at decreased concentrations of haemoglobin, to the same extent as in other types of anaemia. Consequently the need for blood transfusions is less than assumed in these disorders. Ery-ATP is considerably increased in chronic myelocytic leukaemia, the values correlating positively with the 'activity' of the disease. This finding can probably be used for diagnostic and prognostic purposes.
A patient with multiple myeloma is reported with severe hypogammaglobulinaemia but without monoclonal immunoglobulin (M-component) in the serum or Bence Jones protein in the urine. In May-Grünwald-Giemsa stained bone marrow film 45% of the cells resembled plasma cells. Marrow immunofluorescent studies showed no increase of immunoglobulin containing cells. Ultrastructural studies showed a large number of cells with a well developed rough endoplasmic reticulum and other morphological features characteristic for plasma cells.
The occurrence of a monoclonal gammopathy followed by IgG-lambda multiple myeloma is described in a patient receiving diphenylhydantoin therapy for 20 years for epilepsy. Despite the known association between the drug and the development of immunosuppression and lymphoma, we regard the association recorded in this case to be coincidence. It is suggested that periodic examination of the serum proteins in patients receiving the drug may be useful in detecting early aberrations of the immune system in these individuals.
A case of acute myelogenic leukaemia developing after 7 months treatment with alkylating agents for multiple myeloma is reported. The patients was also given irradiation for an expansive process in the thoracic column. By immunofluorescence staining of the bone marrow cells there was no evidence for production of pathological globulins in the blast cells, while the plasma cells contained IgA, kappa.
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The adhesiveness of leucocytes in human plasma was decreased by the addition of IgG M-protein, commercial IgG, F(ab)2-fragments, or bovine serum albumin (BSA). Leucocyte migration was inhibited by IgG M-protein and commercial IgG, but not by reduced and alkylated IgG, F(ab)2-fragments or BSA. Guinea pig serum (GPS) strongly enhanced leucocyte migration in Hanks' balanced salt solution. This effect was abolished by hydrazine treatment or heating, and reduced, but not abolished, by zymosan treatment. C4-deficient guinea pig serum (C4-def-GPS), but not zymosan treated C4-def-GPS stimulated migration. In IgG myeloma sera migration was enhanced by the addition of C4-def-GPS and by untreated or heated, but not hydrazine treated GPS, and inhibited by zymosan treated GPS. IgG M-protein inhibits leucocyte adhesiveness and migration. Migration is specifically inhibited by the intact IgG, probably through complement activation with consumption of heat stable chemokinetic factor(s) and production of migration inhibitors.
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