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Table 1 Summary of laboratory findings on NM at presentation and after each course of Intravenous Immunoglobulin demonstrating transient improvement

From: Combination of acquired von Willebrand syndrome (AVWS) and Glanzmann thrombasthenia in monoclonal gammopathy of uncertain significance (MGUS), a case report

Laboratory parameter

Reference range

Presentation

First course IVIg

Second course IVIg

Third course IVIg

Full Blood Count

 Haemoglobin

12.4–16.7 g/dL

3.5

14.7

13.1

12.7

 Haematocrit

0.35–0.49 UL

0.12

0.48

0.38

0.40

 Red cell Count

3.8–5.5 × 109/L

1.29

5.56

4.88

4.43

 Mean Cell Volume

79–100 fL

89.90

85.60

85.60

89.40

 Mean Cell Haemoglobin

27–35 pg

27.10

26.50

26.80

28.70

 Mean Cell Haemoglobin concentration

29 - 37 g/dL

30.20

31.30

31.30

32.10

 White Cell Count

4-12 × 109/l

4.52

5.14

4.70

2.62

 Platelet Count

150-450 × 109/L

310

245

245

187

 Red cell distribution width

11.0–16.0

22.80

14.10

14.10

13.20

Reticulocyte production

 Reticulocyte production index

1.00–1.25

2.2

  

0.9

Iron Studies

 Ferritin

20-300 ng/mL

7

  

11

Coagulation studies

 INR

1.00–1.25

1.06

  

1.02

 Prothrombin Time

< 14 s

13.2

 

11.8

14.6

 Activated Partial Thromboplastin Time

27–43 s

52.7

  

35.4

 Fibrinogen

1.7–4.2 g/L

3.5

  

3.8

Factor VII levels

 Factor VIII

50–150%

6

48 (7a)

78 (15a)

88 (22a)

 Factor VII inhibitor

Bethesda

0

  

0

Von Willebrand Factor Screen

 Von Willebrand Factor Activity

47.8–173.2%

15

  

32 (6a)

 Von Willebrand Factor Antigen

50–160%

10

52 (10a)

51 (14a)

43 (10a)

Platelet studies

 Agonist - ristocetin 0.5μg/mL

No response

Normal

 

Normal

Normal

 Agonist - ristocetin 1.5μg/mL

60–110%

5

10

10

32 (10a)

 ADP 5.0 uM

60–100%

17

   

 Epinephrine 10μg/mL

60–110%

14

   

 Collagen 2μg/mL

60–110%

3

   

 Arachidonic Acid

 

Decreased

   

Platelet function analyser

 Collagen/Epinephrine

82–150

> 300

   

 Collagen /Adenosine diphosphate

62–100

> 300

   

Liver function tests

 Albumin

35–50 g/L

28

   

 Bilirubin (unconjugated)

3-6umol/L

4

   

 Bilirubin (conjugated)

2–7 umol/L

3

   

 AST

13–35 IU/L

8

   

 ALT

< 35 IU/L

3

   

IgM paraprotein

g/L

3

4

 

4

Urea and Electrolytes

 Sodium

136-145 mmol/L

136

   

 Potassium

3.5–5.1 mmol/L

4.5

   

 Chloride

98-107 mmol/L

108

   

 Total CO2

21-29 mmol/L

23

   

 Urea

2.9–8.2 mmolL

2.5

   

 Creatinine

53–97 umol/L

36

   

Bone Marrow Aspirate

Clonal plasma cells present but < 5% of cells. Iron stores absent.

  1. aResults prior to administration of intravenous immunoglobulin where appropriate