Lab Med Online.  2022 Apr;12(2):129-133. 10.47429/lmo.2022.12.2.129.

A Case of Monoclonal Gammopathy Associated with Aplastic Anemia: Insights into the Etiology and Points to be Considered During Diagnosis

• Woo S
• Kim B
• Bang HI
• Yoon YA
• Choi YJ

• KMID: 2538596
• DOI: http://doi.org/10.47429/lmo.2022.12.2.129

Abstract

Monoclonal gammopathy involves the presence of clonal immunoglobulins, fragments, or free light chains of immunoglobulin in the serum or urine, and is usually considered a sign of plasma cell or B cell malignancies. However, monoclonal gammopathy could also be benign. Here, we present a case of monoclonal gammopathy associated with aplastic anemia, the diagnostic steps, and possible etiologies. Evaluating the cause of monoclonal gammopathy in hypocellular bone marrow could be challenging due to the high proportion of plasma cell and rarity of the combination of these two conditions. Therefore, extensive diagnostic analysis and follow-up tests are necessary to conduct accurate diagnosis.

Keyword

Aplastic anemia; Monoclonal gammopathy; Monoclonal gammopathy of undetermined significance; Immunological dysregulation

Figure

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  Fig. 1 Capillary electrophoresis (EP) and capillary immunofixation electrophoresis (IFE) of the serum and urine samples. (A) Serum EP. (B-F) Serum IFE: (B) IgG, (C) IgA, (D) IgM, (E) Kappa light chain, and (F) Lambda light chain. (G) Urine EP. (H-L) Urine IFE: (H) IgG, (I) IgA, (J) IgM, (K) Kappa light chain, and (L) Lambda light chain.

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  Fig. 2 Immunohistochemical (IHC) staining of the bone marrow (BM) biopsy specimen and multicolor flow cytometric (FCM) immunophenotyping of the plasma cells. (A) Hematoxylin and eosin staining (×200). (B-D) IHC staining of (B) CD 138, (C) kappa light chain, and (D) lambda light chain (×400). (E, F) FCM immunophenotyping of plasma cells in BM aspirate. (G) Result of the lymphocyte subset analysis of BM aspirate using FCM panel corresponding to plasma cell myeloma.

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