A 59-year-old male is seen by his cardiologist for a new restrictive cardiomyopathy. He is found to also have an elevated serum creatinine, and, with concern for amyloidosis, the patient undergoes a fat pad biopsy. Pathologic evaluation displays apple-green birefringence under the polarized light when stained with Congo red dye. His physical exam is unremarkable except for a loud S4 on auscultation of the heart and mild hepatomegaly. Further laboratory workup reveals an elevation of his λ free light chains along with an increased number of plasma cells in the bone marrow.
His CBC is below. Hemoglobin 10.2 g/dL (13.5-17.5 g/dL) WBC 6.8 K/µL (4.0- 11.0 K/µL) Platelet count 154 K/µL (150-400 K/µL) He is treated with the bortezomib-based regimen in three days, but he is admitted to the hospital prior with a GI bleed. Labs on admission to the hospital are as follows. Hemoglobin 8.8g/dL…
