Rouleaux erytrocytov ako predpoklad uvažovania o mnohopočetnom myelóme - kazuistiky
Erythrocyte Rouleaux as an Assumption for Considering Multiple Myeloma - Case Studies

Summary/Abstract: Multiple myeloma is a hematologic malignancy characterized by abnormal plasma cells in bone marrow inducing destructive bone lesions. This disease causes overpopulation of abnormal clonal plasma B cells in bone marrow, bringing downregulation of osteoblasts and activation of osteoclasts, which induce malignant bone lesions, kidney injury, anemia, hypercalcemia, and painful fractures. Criteria for diagnosing MM require the presence of clonal plasma cells in the bone marrow or a biopsyconfirmed plasmacytoma, alongside with traditional CRAB features–hypercalcemia, renal failure, anemia, or lytic bone lesions–or specific biomarkers of imminent organ damage. The current treatment landscape for multiple myeloma involves a combination of proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and autologous stem cell transplantation, which have significantly improved survival outcomes in recent years. However, the disease remains challenging, particularly in relapsed and refractory cases. Changes in blood rheological properties, including plasma viscosity and erythrocyte deformability - rouleaux, are well known in plasma cell dyscrasias, including multiple myeloma and its precursor conditions. Their finding in the microscopic differential count of peripheral blood leukocytes should therefore be a clear signal to exclude them.

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