Multiple myeloma, a hematological malignancy typified by the clonal expansion of bone marrow plasma cells, contributes to one percent of all malignancies worldwide. Despite myeloma only contributing to 10% of all hematological malignancies, it carries significant morbidity owing to its heterogenous presentation from orthopedic manifestations to renal sequelae. Patients with the disease can be risk stratified into high risk categories by the presence of various cytogenetic and other laboratory measures, albeit expensive. The albumin:globulin ratio and its inverse the globulin:albumin ratio is proposed as a means of predicting survival in this group of patients as a cheaper and more accessible marker of disease.

Whilst we suspect that there is no clear association between the two major diagnoses we made in this patient during this hospitalisation (i.e. coronary artery disease and CMT neuropathy), the literature from a series of published case reports does perhaps show an association between CMT and abnormalities of cardiac conduction.

Paroxysmal Nocturnal Hemoglobinuria (PNH) originates from an acquired genetic defect in a multipotent hematopoietic stem cell that becomes stem-cell-like in its ability to survive, expand, and self-renew. PNH is a rare condition characterized by intravascular hemolysis. PNH can arise anew or in the setting of an underlying bone marrow disorder such as aplastic anemia (AA), myelodysplastic syndrome (MDS), or primary myelofibrosis (PMF).This case presentation documents the challenging diagnosis of PNH in the obstetric setting, in which other possible causes for a hemolytic anemia could be considered. We discuss the management of a pregnancy in the presence of PNH in a low-to-middle income setting.