title: Pancytopenia in Multiple Myeloma- An Enigma: Our Experience from Tertiary Care Hospital.
abstract: BACKGROUND
  Multiple myeloma is a plasma cell neoplasm that is characterized by clonal proliferation of malignant plasma cell in the bone marrow along with M-protein in the serum and/or urine. Pancytopenia as a initial presentation of multiple myeloma is quite unusual. We are presenting a case series having pancytopenia as the presenting complaint.
  
  
  METHODS
  A retrospective study was conducted for a period of 30 months, wherein all the cases of multiple myeloma presenting with pancytopenia were included. The complete blood picture, peripheral smear examination, bone marrow aspirate & protein electrophoresis of all the cases were reviewed & analysed.
  
  
  RESULTS
  During the study period, 10 cases presented with pancytopenia with a mean age of 66.3 years (range: 59-72 years) at presentation with male: female ratio being 8:2. Fatigue and weakness was the most common symptom (100%) & average ESR was 104 mm/hour. High-resolution serum electrophoresis, showed a dense, sharp to wide M band in the gamma globulin region. Bone marrow plasma cell percentage was increased with an average of 63.1%. Bone marrow biopsy correlation was obtained in 100% cases.
  
  
  CONCLUSIONS
  Diagnosing multiple myeloma, presenting as pancytopenia requires a high degree of suspicion to avoid delay in initiation of treatment.
authors.affiliation: Assistant Professor, Department of Pathology, Kasturba Medical College , Mangalore, Manipal University, India .
authors.forename: Hanaganahalli B
authors.initials: HB
authors.lastname: Sridevi
authors.affiliation: Associate Professor, Department of Pathology, Kasturba Medical College , Mangalore, Manipal University, India .
authors.forename: Sharada
authors.initials: S
authors.lastname: Rai
authors.affiliation: Assistant Professor, Department of Pathology, Kasturba Medical College , Mangalore, Manipal University, India .
authors.forename: Pooja K
authors.initials: PK
authors.lastname: Suresh
authors.affiliation: Associate Professor, Department of Anatomy, Srinivas Institute of Medical Sciences & Research Centre , Mukka, Mangalore, India .
authors.forename: Meludurgamutt S
authors.initials: MS
authors.lastname: Somesh
authors.affiliation: Assistant Professor, Department of Pathology, Kasturba Medical College , Mangalore, Manipal University, India .
authors.forename: Jessica
authors.initials: J
authors.lastname: Minal
keywords: Clonal proliferation; Initial presentation; Plasma cell neoplasm