A 35-year-old multigravida with a 24-week pregnancy presented with generalized weakness and altered sensorium for 2 weeks. Physical examination revealed pallor and an enlarged uterus corresponding to gestational age. Complete blood counts showed hemoglobin 81 g/L, white cell count 259 ϫ 10 9 /L, and platelet count 71 ϫ 10 9 /L. A review of peripheral blood film (see figure) displayed 90% plasma cells, a bluish background, rouleaux, occasional nucleated red blood, and low platelets. A bone marrow examination showed replacement by plasma cells. Other laboratory tests showed a normal creatinine, uric acid 9.18 mg/dL, lactate dehydrogenase 913U/L, serum calcium (corrected for albumin) 14 mg/dL, and an IgA monoclonal gammopathy. Fetal sonographic evaluation indicated a single living fetus. For medical reasons, her pregnancy was terminated. Treatment was started with hydration, bisphosphonate, and allopurinol, which effectively improved her altered sensorium. There was hematologic improvement after chemotherapy; however, 3 months later her clinical condition deteriorated with the development of renal failure and recurrence of marked elevations of plasma cells. She was treated for her renal failure and further courses of chemotherapy were given. Patient is still alive and stable 6 months after the diagnosis.Only a limited number of cases of myeloma during pregnancy have been described. In addition, the appearance of extraordinary numbers of circulating plasma cells is most unusual in plasma cell leukemia.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit

COVID-19 an ongoing pandemic with high transmission and mortality rate gets the researchers' attention to the disease. The disease burden on the health care system focuses on the COVID-19 impacts on the hematological and biochemical parameters. This study aimed to focus on the laboratory indicators that fluctuate in COVID-19. The single-center cross-sectional study in the pathology department of POF hospital Wah Cantt from August 2021 to December 2021. Three hundred positive COVID-19 patients were included in the study. The138 (46%) were males and 162 (54%) females and the mean age was 58 ± 15.06 (range 5 – 86). The biochemical indicator raised in COVID-19 included CPK (191.25 ± 507.39), CRP (68.81 ± 70.95), LDH (429.48 ± 246.96), and ALT (46.50 ± 43.23). In hematological parameters, only neutrophils elevated (70.00 ± 13.52) lymphocytes decreased. Laboratory parameters measured were similar values in recovered and death cases. The findings suggest the raised level of CRP, LDH, CPK, ALT, ferritin, D-Dimer, and neutrophils predict the early diagnosis and prompt treatment.

COVID-19 an ongoing pandemic has high transmission and mortality rate gets the attention of researchers to focus on the disease. The burden of disease on the health care system focuses on the COVID-19 impacts on the hematological and biochemical parameters. This study aimed to focus on the laboratory indicators that fluctuate in COVID-19. The single-center cross-sectional study in the pathology department of POF hospital Wah Cantt from August 2021 to December 2021. Three hundred positive COVID-19 patients were included in the study. About 138 (46%) were males and 162 (54%) females and the mean age was 58 ± 15.06 (range 5 – 86). The biochemical indicator raised in COVID-19 included CPK (191.25 ± 507.39), CRP (68.81 ± 70.95), LDH (429.48 ± 246.96), and ALT (46.50 ± 43.23). In hematological parameters, only neutrophils elevated (70.00 ± 13.52) lymphocytes decreased. Laboratory parameters measured were similar values in recovered and death cases. The findings suggest the raised level of CRP, LDH, CPK, ALT, ferritin, D-Dimer, and neutrophils predict early diagnosis and prompt treatment.