Diagnosing plasma cell dyscrasias

Remember this pearl covered in CUH morning report last week regarding the sensitivity of the work-up for myeloma spectrum disorders:

  1. SPEP alone – sensitivity is 82%
  2. SPEP plus immunofixation– sensitivity is 92%
  3. SPEP plus immunofixation plus either Serum free light chains OR UPEP– sensitivity is 98%

At CUH & Parkland, the new SPEP always reflexes to immunofixation, so really what you should remember to do is send either the serum free light chains or the 24-hour UPEP, keeping in mind that SFLC is much easier logistically to do. If patients are admitted anyway, though, in practice, hematologists will recommend obtaining all 3 SPEP / SFLC / 24-hr UPEP.

 

Viral Arthritis

This week at CUH MR, we talked about viral arthritis:

– Viral arthritis – responsible for about 1% of all cases of acute arthritis

– World-wide, parvovirus B19, hep B / C, HIV, and arboviruses (specifically alphaviruses, which includes chikungunya) are the most important causes of virally mediated arthritis

  • Most commonly, viruses will cause a symmetric polyarthritis (similar in distribution to RA); HIV – arthralgias are more common than true arthritis

– Serologic testing may help the diagnosis but also helpful are associated clinical features that point to a specific virus (slapped cheek rash in parvovirus; jaundice related to hepatic injury in hepatitis viruses)

– Treatment goals are relief of symptoms and maintenance of function: acetaminophen / NSAIDs in doses typically used in inflammatory arthropathy like RA; steroids are discouraged because of limited utility in most viral arthritis; there is no role for anti-virals because the illness is self-limited in most cases

R2s Dr Eule and Dr Sumarsono Publish!

 

 

It’s been a big week for our second-year residents as two of them have had first author publications.

Eule Paper

Dr. Corbin Eule had his publication “The Direct Antiglobulin Test for Evaluating Anemia” published in JAMA this week as part of their Diagnostic Test Interpretation series. Dr. Eule presents a patient case and the results of their labs and asks the reader to interpret them in a multiple-choice question. He then provides a nice overview of the DAT test. Co authors on the paper include Dr. Arjun Gupta (former chief resident and current hematology/oncology fellow at Johns Hopkins) and Dr. Srikanth Nagalla (hematology/oncology fellowship program director). Read the paper here.

Sumarsono Paper

Dr. Sumarsono had his publication “A 57 Year-Old Man With Subacute Progressive Hemoptysis and Fevers” published in CHEST. The paper details a case of a man presenting with hemoptysis and found to have an unusual diagnosis that was first considered after a specific physical exam finding. Co-authors on the paper include Dr. Timothy J Brown (current chief resident), Dr. Stan Atkin (former resident, current OHSU hospitalist), and Dr. Jason Clark (intensivist). Read the paper here.