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An 80 year old male presented with anaemia. Hemogram reveals RBC count 3.04 × 106/uL (reference range 94-60), Hb 7.8 g/dl, HCT 27.6, MCV 87.8 fl, MCH 25.7 PG, RDW 18.4%, platelets count 169 × 103/uL, total leukocyte count 4.45 × 103/uL, absolute neutrophil count 1.98 × 103/uL, lymphocyte count 1.1 × 103/uL. Peripheral blood smear showed mild roulaeaux formation with rare circulating plasma cell. His Laboratory investigations showed normal renal profile, normal liver enzymes, total protein was 8.8 g/dL, albumin 3.5 g/dL, ESR 68 mm/Hour, PSA was 10.6 ng/mL (normal value less than 4). Bone marrow examination done to rule out plasma cells dyscariasis. It showed hypercellular bone marrow with active trilineage hematopoiesis and prominent monocytes, some histocytes with hemophagocytic activity and many smudge cells. Plasma cells represent 15% of nucleated marrow cells with some of those plasma cells have intracytoplasmic inclusions of variable size ( Russell bodies) arranged in grape-like structure giving eccentric nucleus (Mott cell). Other Mott cell showed internuclear inclusions (Dutcher bodies).
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