Search

Background: Non-secretory multiple myeloma is a sporadic type of multiple myeloma with the proliferation of monoclonal plasmocytes in the bone marrow that cannot secrete or synthesize immunoglobulins. Its prevalence as a hematologic malignancy is low, and it is usually diagnosed by demonstration of monoclonal plasma cells ≥ 10% in the bone marrow with negative results on serum and urine electrophoresis and immunofixation studies. Methods: We present a case report where the patient's serum and whole blood samples were received in the study laboratory to evaluate the complete hemogram and metabolic profile. The metabolic and hematological profiles were deranged, subsequent to which the patient's clinical history was obtained from the treating clinician. It was discovered that the patient had presented with long-term weakness and back ache and was advised routine investigations along with magnetic resonance imaging (MRI) of the spine, which revealed the presence of osteolytic lesions. Following this, a gammopathy panel was requested. Results: Serum protein capillary electrophoresis and immunofixation electrophoresis revealed a normal pattern without any noticeable bands, distortions, or suspicious regions. However, the findings of the comprehensive gammopathy panel were suggestive of non-secretory multiple myeloma. Conclusion: In the absence of a detailed and meticulous work-up, a case of non-secretory multiple myeloma can be easily misdiagnosed. Here, we discuss the case in detail, the diagnostic pitfalls associated with it, and the role of serum free light chain assays in its diagnosis.

Primary polydipsia (PP) is a disorder that is clinically characterised by excessive thirst accompanied by increased fluid intake and subsequent excessive excretion of urine without an obvious cause. PP in childhood due to psychogenic causes is a rare condition and may be more prevalent than thought. The differential diagnosis of polydipsia and polyuria is broad due to extensive associated disease spectrum, including renal, endocrine, and neurological diseases. Furthermore, differentiating PP from diabetes insipidus (DI) is essential because the treatment of the latter could be deleterious in patients with PP. We present the case of a 3-year-old boy who presented with psychogenic polydipsia. In the present case, the child was started on desmopressin, considering it a case of DI, in view of the history of increased water intake and urinary output. However, a detailed psychological assessment of the child revealed the case to be an autism spectrum disorder. Subsequently, desmopressin was discontinued, and there was a rapid normalisation of fluid intake along with significant reduction in the urine output after starting psychological intervention and implementing strict water restriction. This confirmed the diagnosis as a case of psychogenic polydipsia, which is a common occurrence in children with developmental disorders.

Aims and background: Autoverification (AV) is an application of artificial intelligence that uses computer-based algorithmically established rules for release of patient reports. This allows effective time management, prevents probable laboratory errors, and ensures consistent results. However, not many labs have adopted AV into practice due to hesitations concerning cost-effectiveness, lack of robust software and informatics support along with dearth of knowledge for its implementation. Additionally, there is scant published literature on AV implementation. This study has been conducted as an attempt to outline benefits of AV and address the existing gaps. Methods: The study was conducted in the Department of Clinical Chemistry of a standalone lab. Autoverification implementation was done in stepwise manner. (i) Test selection and developing algorithms, (ii) Setting-up rules in middleware to prevent release of erroneous results, (iii) User acceptance testing (UAT), (iv) Going-live. Results: Efficacy of AV system was gauged based on following factors. (i) AV passing rate—initial 53.7–85.4% later was achieved with inclusion of more parameters and extension of tolerance limit, (ii) Significant improvement was observed in TAT for both immunoassay (from 88.28 to 97.32%) and routine chemistry (from 82.7 to 95.68%), (iii) decreased error rates as evidenced by reduced number of amended reports, (iv) reduction in staff required for manual verification allowing their utilization for other departmental activities. Conclusion: Implementation of AV by laboratories provides efficient and cost-effective work opportunities with scope for continuous growth. However, it doesn’t preclude the need for careful quality control.

Monoclonal Gammopathy (MGM) is a group of B-cell disorders characterised by secretion of abnormal monoclonal Immunoglobulin (Ig) that can be detected by presence of M-protein in serum and urine electrophoresis. Monoclonal protein (M-protein) can be best identified by high resolution agarose gel electrophoresis where, it is usually perceived as a discrete band in the γ or β globulin region. Sometimes atypical banding patterns are seen in serum capillary electrophoresis that pose diagnostic dilemmas and may require repeat testing and further confirmation with a diagnostic test. In the present case, A 60-year-old female patient was advised assessment for gammopathies owing to the presence of skeletal lesions and hyperproteinemia clinically. Serum protein capillary electrophoresis revealed an unusual pattern with three prominent bands in the beta/early gamma region, indicative of triclonal gammopathy, although, it was monoclonal in nature which was depicted during confirmatory diagnostic testing. The authors further discuss the multiple aspects that may be attributed as a cause for such peculiar presentations which should be considered to avoid misdiagnosis.

Hypertension remains one of the most significant causes of mortality, affecting more than 1 billion people worldwide. It is a significant public health concern and a major risk factor for renal disease, heart failure, stroke, coronary artery disease and peripheral vascular disease. In more than 90% of hypertensive patients, the cause of blood pressure elevation is unknown. Therefore, early diagnosis and timely interventions are crucial to prevent complications. Over the last four decades, various blood biomarkers have been identified, which can help in understanding the cause of the underlying processes involved in the onset, development and progression of hypertension (HT). It is our attempt, in this review, to suggest a more robust use of circulating biomarkers that may prove to be beneficial in better elucidating the pathophysiology, development, progression and therapeutic efficacy in the management of HT.