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Slide 23
The usual finding in the blood of patients with MM is rouleau formation of the red blood cells due to coating by paraprotein. The differential white blood cell count may be normal or show a shift to younger forms of granulocytes or nucleated red blood cells or to a relative lymphocytosis if leukopenia is present. A few plasma cells usually can be found in the blood in most cases of MM if a careful search is made. The platelet count may be normal or decreased. The erythrocyte sedimentation rate is generally elevated owing to rouleaux.

This slide of blood is not the usual one seen in MM. This is blood from a patient with plasma cell leukemia. One percent of cases of myeloma will present with this finding. The cells are usually variable in size and shape and have only a small amount of cytoplasm. They can be mistaken for abnormal lymphocytes. The leukocytosis in plasma cell leukemia is due to a 50% or greater concentration of plasma cells.


HEMATOLOGY
Course Section: 10. Plasma Cell Dyscrasias
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