MRCP2-2300

MRCP2-2300

A 67-year-old woman is admitted to the hospital with headaches and visual disturbances. The patient has a history of multiple myeloma. During her stay, she experiences a persistent nosebleed that is difficult to control. Fundoscopy reveals dilated retinal veins and retinal hemorrhage in her left eye. She appears pale and short of breath, with a blood pressure of 120/70 mmHg, a heart rate of 110 bpm, and a temperature of 38 °C. The on-call ENT surgeon is consulted to pack her nose. After receiving plasmapheresis, she makes a good recovery. Her blood tests one week later show:

Hemoglobin (Hb) 95 g/l 120–160 g/l
Platelets (PLT) 100 × 109/l 150–400 × 109/l
Mean corpuscular volume (MCV) 98 fl 80–100 fl
Reticulocytes 120 × 109/l 25–85 × 109/l
Lactate dehydrogenase (LDH) 800 IU/l 140–280 IU/l
Immunoglobulin G (IgG) 50 g/l 6–16 g/l
Beta-2 microglobulin 8 mg/l 1.3–2.9 mg/l
Albumin 30 g/l 35–55 g/l

Which of the following factors in this patient’s case contributes to a worse prognosis?