I recently saw a 70-year-old gentleman who was feeling tired and short of breath. He saw his lung doctor, who did blood work and found he was severely anemic. An iron study showed low iron. He was advised to come and see me.
Most people think anemia means low iron; this is sometimes true, but not always. He needed an outpatient blood transfusion. He was given IV iron. Further workup showed that he had abnormal protein in his blood.
These proteins grow from a small number of plasma cells in the bone marrow. Plasma cells are a type of white blood cells. Their main job is to fight off infection.
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I was very concerned because his anemia was very severe and I felt that he had another cause of anemia hiding behind his iron deficiency. I advised him to undergo a bone marrow biopsy. This is an outpatient procedure done in my office. It takes less than 10 minutes to complete and it is done under local anesthesia. He tolerated it well. As I expected, it showed that he had multiple myeloma.
This is cancer of plasma cells in the bone marrow. Normal bone marrow has 2 percent or so plasma cells and he had almost 75 percent. This crowds the bone marrow, so normal cells have no space to grow and make blood cells. That caused his anemia.
Myeloma causes structural bone damage, which can result in weakened bones and leads to painful fractures or bone breaks over time. This causes anemia, sometimes high calcium, kidney damage. This is a highly-treatable condition. There are many new advances in myeloma.
My patient is started on outpatient therapy and is responding very well. His anemia has markedly improved. He does not need any more blood transfusions.
Patients with multiple myeloma tend to have years of good quality of life. Many patients can live more than 10 years. He is already feeling a lot better himself.
If his anemia was ignored, he could have come in with significantly more problems, including the need for dialysis. I see lots of patients with anemia and some of them have significant problems which are masked or remain undetected.
His cancer presented with anemia and fatigue. Sometimes, it presents with unexplained weight loss. Cancer can have odd presentations. It helps to keep one’s mind open to the possibility of cancer.
Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email firstname.lastname@example.org or call 352-746-0707.
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