58-year-old nuclear power plant worker presented to his familyphysician complaning of increasing fatigue and weakness. He alsoreported pain in his lower back and arms when he walks. Physicalexamination revealed pale mucous membranes and hepatosplenomegaly.The physician ordered a complete blood count (CBC) and urinalysis(UA). A follow-up appointment was scheduled for the followingweek.

Laboratory Data:

The CBC revealed that the patient had anemia. His leukocytecount and differential count were normal, except for a rouleaux(rolled coin) appearance of the RBCs. The UA was normal. Thepatient was called and requested to return to the laboratory foradditional tests. The physician ordered an ESR, kidney screeningprofile, liver blood profile, and radiographic skeletal survey,with the following results:

• ESR—50 mm/hr

• Kidney profile—normal

• Liver profile—normal, except for increased globularprotein

• Skeletal survey—bone lesions in various sites

Questions:

1. What follow-up laboratory tests might be ordered to assist inestablishing a definitive diagnosis?

2. What is the nature of the urine protein found in thisdisorder ?

3. What is the most significant laboratory finding in thisdisorder?

4. What type of immunologic defect exists in this diseaseprocess?

5. Does this patient have a risk of occupational exposure?