Unfortunately, subsequent serum protein electrophoresis revealed the presence of a M-protein band with a paraprotein quantitation of 15.7g/L and urine protein electrophoresis showed the presence of urine
Bence-Jones protein with a quantitation of 4.4 g/L.
These would include: (1) no histologic evidence of plasmacytoma/plasmacytosis in bone marrow; (2) negative blood investigations and no clinical signs and symptoms of myeloma (e.g., bone pain, anemia, renal failure); and (3) no urine monoclonal gammopathy (
Bence-Jones proteins) or osteolytic lesions on plain films.
% (c) (d) 1 82 -1184 0.89 2 69 - 443 0.99 3 71 -167 0.83 4 82 -208 0.72 5 89 404 0.43 6 100 -509 0.69 7 87 89 0.59 8 89 -305 0.52 9 80 -603 0.75 10 78 -1588 0.90 11 75 181 0.84 12 110 294 0.98 13 85 2315 0.96 14 73 315 0.74 Abbreviations: BJP,
Bence-Jones protein; CV, coefficient of variation.
Bataille and Sany critria,1 for SPB include an isolated tumor composed a clonal proliferation of plasma cells; absence of lesions on skeletal radiographic survey; absence of plasmacytosis in the bone marrow; and absence of anemia,
Bence-Jones proteins in urine or hypercalcemia.
Recently, however, he had had a relapse, developing increased levels of
Bence-Jones proteins in the urine as well as plasma cell infiltration and decreased kidney function.
Serum electrophoresis for paraproteinaemia confirmed a free lambda light-chain band in the gamma-region with a kappa/lambda ratio of 0.06; urine electrophoresis demonstrated
Bence-Jones proteins.
Free light chains are also produced along with intact proteins; these light chains are detected by urine protein electrophoresis and are designated as
Bence-Jones proteins. Excess cytokines activate osteoclasts, leading to bone destruction and subsequently to discrete lytic lesions or diffuse osteopenia.
Because of increased immunoglobulins, the ESR is high: >20 mm/hour in 85% and >100 in one third.10 Elevated creatinine is seen in 50% and hypercalcemia in 25%.10 Urinalysis is typically negative (
Bence-Jones proteins are not detected by dipstick) unless there is amyloidosis or light chain deposition disease leading to albuminuria.
Turbidimetric measurement of
Bence-Jones proteins using antibodies against free light chains of immunoglobulins.
Urine protein electrophoresis was negative for
Bence-Jones proteins. A bone marrow aspirate was notable for a 45% plasmacytosis.