Papel central del laboratorio en el diagnóstico de un caso de infiltración de sistema nervioso central por mieloma múltiple refractario

Abstract

Leptomeningeal involvement in multiple myeloma is a rare and serious complication that usually occurs after relapses of the disease. To establish a correct diagnosis, it is necessary to demonstrate, by cytology, the presence of clonal plasma cells in the cerebrospinal fluid.

The clinical laboratory detected this complication in a patient diagnosed with refractory multiple myeloma after analysing a cerebrospinal fluid sample. The patient suffered from several neurological symptoms, such as faecal incontinence and lower limb mobility limitation. Pleocytosis and proteinorachia was initially observed, along with high levels of high-fluorescence cells, which are sometimes associated with malignant cells. The protein electrophoresis and immunofixation of the cerebrospinal fluid confirmed the presence of the monoclonal component, already detected in blood. After processing the sample by flow cytometry it was confirmed that there was infiltration of malignant plasma cells in the central nervous system.

This laboratory played a central and essential role in the diagnosis of this uncommon complication, by the combined use of protein electrophoresis, immunofixation, flow cytometry, and the haematology autoanalyser. This latter included the high fluorescence cells as a promising biomarker in the screening for the presence of tumour cells in biological fluids.