Most complications of Type II diabetes mellitus such as micro and macrovascular disease are the result of which of the following?

A. T cells: T lymphocytes are primarily involved in cell-mediated immunity and are implicated in conditions such as lymphomas and certain leukemias. Multiple myeloma does not originate from T-cell lines. The disease process specifically affects antibody-producing cells rather than cell-mediated immune cells.

B. B cells: Multiple myeloma arises from malignant transformation of B lymphocytes that have differentiated into plasma cells. These abnormal cells produce excessive amounts of a single immunoglobulin, leading to characteristic clinical features. The neoplasm is therefore classified as a disorder of the B-cell lineage.

C. Immature plasma cells: Immature plasma cells are more commonly associated with plasma cell leukemia or early precursor disorders. Multiple myeloma involves clonal proliferation of plasma cells that are typically mature rather than immature. The disease reflects abnormal antibody production rather than early cell precursors.

D. Mature red blood cells: Mature red blood cells are responsible for oxygen transport and are not involved in neoplastic immune disorders. While anemia may occur as a complication of multiple myeloma, erythrocytes are not the malignant cell type. They are affected secondarily due to marrow infiltration.

A. Haemophilia: Hemophilia is a hereditary bleeding disorder caused by clotting factor deficiencies. It primarily affects coagulation and does not cause low hemoglobin or hematocrit. Mr. Brown shows no signs of abnormal bleeding, making this unlikely.

B. Infection: Infections often present with elevated white blood cell counts or changes in differential. Mr. Brown’s leukocyte count and differential are within normal limits, indicating infection is not the primary cause of his symptoms.

C. Anemia: Low hemoglobin (90 g/L) and hematocrit (.97 L/L) indicate reduced oxygen-carrying capacity of the blood. His fatigue and poor dietary intake of iron-rich foods support a diagnosis of anemia, likely nutritional in origin.

D. Platelet deficiency: A platelet deficiency would present with thrombocytopenia and increased bleeding risk. Mr. Brown’s platelet count is within normal limits (300 × 10⁹/L), so platelet deficiency is not contributing to his condition.