Resident Program - Case of the Month

October 2023 – Presented by Dr. Erdembileg “Beke” Chuluunerdene (Mentored by Dr. Clayton LaValley)

Discussion and Clinical Implications

The discovery of monoclonal gammopathy in this case sheds light on the potential for laboratory anomalies, such as an elevated lipemic index, to indicate underlying, more complex conditions. The case aligns with findings from studies such as those by Agrawal et al. and Guimaraes-Young et al., identified 25 such instances out of more than 160,000 samples examined. Importantly, the research revealed that about half of these incongruities were linked with a previously undetected monoclonal gammopathy. (1, 2)

This case emphasizes the importance of a thorough and multidisciplinary approach in the evaluation of laboratory anomalies. It highlights the need for clinicians and laboratory personnel to be cognizant of the less common but clinically significant conditions that may present through atypical laboratory results. The findings from this patient's case serve as a critical reminder of the importance of considering a broad differential diagnosis when faced with unusual laboratory data.

Citations

1. Agrawal, Y. P., and Hall, K. (2019). "The Lipemia Index: An Underutilized Tool to Detect Monoclonal Proteins". The Journal of Applied Laboratory Medicine, 3(6), 1062–1064. https://doi.org/10.1373/jalm.2018.028456
2. Guimaraes-Young, A., and Agrawal, Y. (2019, June 1). "The Curious Incident of the False Lipemia Index Alert". Bench Matters, 25(6).
3. Oosterhuis, W., Kleinveld, H., and Mücke, M. (2009). "Detection of a monoclonal gammopathy by serum index measurement". Clinical Chemistry and Laboratory Medicine (CCLM), 47(5), 614–615.