A 74-year-old man returns to his physician to follow-up on laboratory studies obtained for anemia 2 weeks ago. He has no complaints. He has a 20-year history of hypertension and several years of knee osteoarthritis. He walks 2 miles a day. He does not smoke. He drinks alcohol moderately. He takes hydrochlorothiazide, losartan, and pain killers, including ibuprofen. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 12/min, and blood pressure 110/70 mm Hg. The physical examination shows no abnormalities. The laboratory studies show the following:
Laboratory test
Hemoglobin 10 g/dL
Mean corpuscular volume 75 μm3
Leukocyte count 5,000/mm3
Platelet count 350,000/mm3
ESR 18 mm/hr
Serum
Ferritin 5 μg/L
Iron 30 μg/L
Total iron-binding capacity 500 μg/dL
Calcium (Ca+) 9 mg/dL
Albumin 4 g/dL
Urea nitrogen 14 mg/dL
Creatinine 0.9 mg/dL
Monoclonal protein on serum electrophoresis is 12 g/L (non-IgM). Clonal bone marrow plasma cells comprise 4% of the total number of cells. Skeletal survey with magnetic resonance imaging reveals no pathologic findings. In addition to iron deficiency anemia, which of the following diagnosis is most appropriate to consider?
August 31, 2026 4
