Case Report

Pseudohypercalcemia in Multiple Myeloma: A Case Report

Abstract

Hypercalcemia is a common finding in patients with multiple myeloma. Clinical manifestations of hypercalcemia correlate with the level of serum calcium. Ionized serum calcium (Ca (I)) will be increased in true hypercalcemia. In pseudohypercalcemia the Ionized Ca is normal, although binding of calcium to abnormal immunoglobulin causes increased serum calcium level. In the asymptomatic multiple myeloma patients with moderate to severe hypercalcemia, measurement of ionized calcium is critical to exclude pseudohypercalcemia. Here, we describe an asymptomatic 44-year-old man with multiple myeloma who had severe hypercalcemia, but normal serum Ionized Ca level. 

Shane, E, Dinaz, I. Hypercalcemia: Pathogenesis, clinical manifestations, differential diagnosis, and managment. In: Favus, MJ, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. Sixth ed. Philadelphia: Lippincott, Williams, and Wilkins. 2006; 26: 176.

Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma .Mayo Clin Proc; 2003;78(1):21

Inzucchi SE. Understanding hypercalcemia.Its metabolic basis, signs, and symptoms. Postgrad Med 2004; 115(4):69-70

Endres DB, Rude RK. Mineral and Bone Metabolism. In: Burtis CA, Ashwood ER, eds. Tietz'Textbook of Clinical Chemistry. 2nd ed. Philadelphia: WB Saunders, 1994: 1887-1899.

Wallach J. Interpretation of Diagnostic Tests. Boston: Little, Brown and Company, 1996: 49-52.

Howanitz PJ, Howanitz JH. Laboratory Medicine. NewYork: Churchill Livingstone, 1991:296-299.

Sachmechi I, Shah G, Rezainadimi L, et al. Misleading acute hypercalcemia due to hyperlipidemia. Endocr Pract 1997; 3(5): 293-296

Wenk RE, Yoho S, Bengzan A. Pseudohypoglycemia with monoclonal immunoglobulin M [letter]. Arch Pathol Lab Med. 2005; 129: 454-455.

Pantanowitz L, Horowitz GL, Palakalin JN, et al. Artifactual hyperbilirubinemia due to paraprotein interference. Arch Pathol Lab Med. 2003; 127 (1):55-9.

Smogorzewska A, Flood JG, Long WH, et al. Paraprotein interference in automated chemistry analyzers. Clin Chem. 2005; 51(6):1077-8

Lyon AW, Baskin LB. Pseudohyponatremia in a myeloma patient: direct electrode potentiometry is a method worth its salt. Lab Med. 2003;34(5):357-360.

Bern M. Clinically significant pseudohyponatremia. Am J Hematol.2006; 81(7):558-9.

Rhys J, Oleesky D, Issa B, et al. Pseudohypercalcaemia in two patients with IgM paraproteinaemia. Ann Clin Biochem. 1997; 34(6):694-696.

Reed RG. Interference by an IgM paraprotein in the bromcresol green method for determination of serum albumin. Clin Chem. 1987; 33(6)1075-1076

Schwab J, Strack M, Hughes L, et al. Pseudohypercalcemia in an elderly patient with multiple myeloma: report of a case and review of literature. Endocr Pract. 1995; 1(6):390-2.

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IssueVol 11, No 3 (2017) QRcode
SectionCase Report(s)
Keywords
Multiple myeloma Psudohypercalcemia

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Ashrafi F, Iraj B, Nematollahi P, Darakhshandeh A. Pseudohypercalcemia in Multiple Myeloma: A Case Report. Int J Hematol Oncol Stem Cell Res. 2016;11(3):247-250.