Question

Sophia O'Connor was a 56 year old attorney in 2011, when she began to experience excessive fatigue. She had been in good health her entire life. Her 53 year old husband (Alvin), a chef and unpublished author, was also in good health, as were their three sons, all in their 20's. At the time of a routine annual check-up she told her physician of how easily she tired. The physician found no abnormalities on physical examination, however she did order blood and urine work A blood sample revealed that Sophia had mild anemia, her red blood cell count was 3.5 x 106 rbc per ul (normal = 4.2 - 5.0 x 109 per pl). Her white blood cell count was 3,400 wbc perul (normal = 5,000 per ul). The sedimentation rate of her red blood cells was 33 mm per hr (normal < 20 mm per hr). Because sedimentation rates tend to be elevated when the fibrinogen or the IgG content of plasma is elevated, the concentration of lg were determined. The concentration of IgG was found to be 3,790 mg per dl (normal = 600 - 1500 mg per dl), that of 19A 14 mg per dl (normal = 150 - 250 mg per dl) and that of IgM 53 mg per dl (normal = 75 - 150 mg per dl). A urine sample revealed the presence of Bence Jones proteins in the urine. Radiographs of her bones showed no abnormalities. No treatment was advised. Ms O'Connor returned for regular visits to her physician and on each occasion she measured Sophia's serum IgG level, noting it was slowly increasing. In February of 2013 her serum IgG level was 4,620 mg per dl, in January of 2012 it was 5.200 mg per di and by November of 2012 it was 5,600 mg per dl. By this time her anemia had worsened and the red cell count fallen to 3,000 wbc per pl, with 2,900 wbc per pl. A month later, Ms O'Connor experienced a sudden onset of lower back pain. She was referred to a radiologist. He reported finding a deformity of the L4 vertebrae. An MRI (below left) revealed the extrusion of a plasmacytoma from the affected vertebral body compressing the spinal cord. Biopsy of the plasmacytoma and adjacent bone marrow revealed revealed a predominant population of plasma cells (below right). MRI Bio Wikipedia Ms O'Connor was treated with the corticosteroid decadron and irradiation of the spine. Her symptoms improved, however, her serum IgG level reached 7,320 mg per di and she required blood transfusions to treat her worsening anemia. She was treated with melphalan and prednisone.

Answer 1

1, Multiple myeloma:
It is cancer formed by malignant plasma cells. this patient diagnosed with this disease due to a patient biopsy report shows plasma cyloma and bone marrow revealed predominant accumulation of plasma cells(a form of WBC). plasma cells become cancerous and multiples, it damages the bone, immune system, and RBC count. patient anemic condition and high IgG level cause multiple organ damage and patient experience with various symptoms indicate the patient is having multiple myeloma. presence of Bence-jones protein int the urine indicates the immunoglobulin light chain in the urine causes multiple myeloma.
2, Myeloma cells disturb the blood cells form in the bone marrow. so there is less RBC or anemia. There are multiple formations of plasma cells in the bone marrow that interfere with the normal blood-forming cells that cause low WBC.
3, Pyogenic infection is pus producing infection with strains of staphylococcus aureus that cause pneumonia and renal dysfunction. this happens mainly due to the humoral immunity defect or functional impairment of natural killer cells and polyclonal hypogammaglobulinemia.
4, Antibody play an important role in acting against particular microorganism. IgG autoantibodies react with human molecules contribute to the pathogenesis. Streptococcus are gram-positive, that occur in pairs or chains. emergence of S pyrogens resistant to penicillin and other antibiotics, it becomes a microbial threat. S pyogenes are part of normal human nasopharyngeal flora, that cause inflammation in the respiratory tract, bones, and joints. S.pyogenic recurrence is common, life long antibiotics prophylaxis is recommended. Antibiotic resistance must be treated with these common pathogens.