Smoldering Multiple Myeloma

year old female patient presented with complaint of persistent weakness and pedal oedema.Her hemo- globin level was fluctuating between 8-10gm% which was not improved even after blood transfusion , iron and folic acid supplements.We ruled out all possible causes of pedal oedema.Total Protein ,Albumin , Globulin and A/G ratio was done. Globulin was 6.3gm%(increased).A/G ratio was reversed.ESR was markedly elevated.Protein electrophoresis was done which showed M-Band.Bone marrow showed 22% of plasma cells.Trephine biopsy was done which showed interstitial infiltrate of about 20% of plasma cells.S.creatinine ,S.calcium were normal.X-ray skull,pelvis and hip joint were normal.Diagnosis of Smoldering multiple my- eloma was put. Patient was put on Dexamethasone and pamidronate.She was followed after 3 months with protein electrophoresis and other biochemical reports.