title: Presumptive increase in protein-bound serum calcium in a dog with multiple myeloma.
abstract: An 11-year-old male castrated Australian Shepherd was presented with a history of lethargy, panting, and weight loss for 1 month. Physical examination revealed a moderately enlarged spleen. Laboratory abnormalities included thrombocytopenia and marked hypercalcemia, with hyperglobulinemia, hypoalbuminemia, and a monoclonal spike in the beta-globulin region on serum protein electrophoresis. Serum total calcium concentration was markedly increased (16.5 mg/dL, reference interval 8.9-11.4 mg/dL) but ionized calcium concentration (1.39 mmol/L) was within the reference interval (1.25-1.45 mmol/L). Isosthenuria was noted, but the dog was not polyuric or polydipsic. Serum parathyroid hormone concentration was within reference limits and parathyroid hormone-related peptide concentration was 0 pmol/L. Radiographic findings were largely unremarkable. Results of cytologic evaluation of a fine-needle aspirate specimen from the spleen indicated plasma cell neoplasia. Based on the results of the electrophoresis, splenic aspirates, radiographs, and hypercalcemia, a diagnosis of splenic multiple myeloma was made. The marked hypercalcemia, normal ionized calcium and parathyroid hormone concentrations, and lack of osteolytic lesions indicated a presumptive increase in protein-bound serum calcium, likely due to binding to molecules of the paraprotein (M protein). Protein binding of calcium in dogs with multiple myeloma should be considered as a potential mechanism of elevated total serum calcium concentration.
authors.affiliation: Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-7060, USA. trippc@vetmed.wsu.edu
authors.forename: Chelsea D
authors.initials: CD
authors.lastname: Tripp
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bryan
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Wills
mesh_terms: D000818:Animals; D002118:Calcium / Q000097:blood*; D004283:Dog Diseases / Q000097:blood* / Q000378:metabolism; D004285:Dogs; D006934:Hypercalcemia / Q000097:blood / Q000662:veterinary*; D008297:Male; D009101:Multiple Myeloma / Q000097:blood / Q000378:metabolism / Q000662:veterinary*
chemical_list: D002118:Calcium