89 一位69歲女性病人主訴近1個月逐漸加劇之背痛病史。影像檢查顯示T11脊椎體塌陷，胸椎體及腰椎體並有多個骨溶解變化。骨髓抹片如附圖。下列併發變化中，何者較少見？

 高鈣血症（hypercalcemia）

紅血球沈降率（erythrocyte sedimentation rate）增加

漿細胞白血病（plasma cell leukemia）

類澱粉沈積（amyloidosis）

CASE OF MULTIPLE MYELOMA

ANSWER IS C, NOT COMMONLY SEEN

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90 一位58歲女性病人之血清中鐵（iron）及全鐵質結合能力（total iron-binding capacity, TIBC）兩者之值均較低，但含鐵蛋白（ferritin）較高。下列何者為可能的原因？

 慢性病引起之貧血 自體免疫溶血性貧血

維生素B12缺乏 缺鐵性貧血

A

NOTE THAT IN ANEMIA OF CHORNIC ILLNESS, THE TOTAL CALCIUM IS DECREASED BUT THE FERRITIN IS INCREASED. FERRITIN IS HOLDING THE CA INTRACELLULARLY.!

• In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron. In iron deficiency anemia ferritin should be low.

• TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce more transferrin and bind up as much iron as possible; TIBC should be low or normal in anemia of chronic disease.

Condition	Serum iron	Transferrin and TIBC	Percent transferrin saturation
iron deficiency anemia	Low	High. The liver produces more transferrin, presumably attempting to maximize use of the little iron that is available.	Low, as there is insufficient iron.
anemia of chronic disease	Low, as the body holds iron intracellularly withferritin.	Low. The body produces less transferrin (but more ferritin), presumably to keep iron away from pathogens that require it for their metabolism.	Normal
pregnancy or use of hormonal contraception, but without iron deficiency	Normal	High. The liver increases the production of transferrin, thus raising TIBC.	Low, as there is excess transferrin with normal serum iron levels.