vi medicine informatics




Patient presents to the emergency department with a presumed fracture of the right femur, as well as long-standing issues concerning bone pain, dyspnea, and fatigue. Her lab findings reveal pancytopenia, proteinuria, and hypercalcemia, which strongly suggest that her fracture is pathologic, due to an underlying multiple myeloma (MM). As seen in this patient, MM can manifest with pancytopenia with anemia, thrombocytopenia, leukopenia, and a decreased reticulocyte count. Bone marrow is actively suppressed due to the hyperproliferation of plasma cells. A history of bone pain and pathologic fracture is also common, especially in the setting of hypercalcemia. The bone pain is caused by lytic lesions, which release calcium, causing hypercalcemia.

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