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Heavy chain diseases are rare gammopathies characterized by the production of a truncated heavy chain monoclonal immunoglobulin without associated light chain. These hemopathies, which are frequently associated with immunological or hematological disorders, are clinically closer to lymphomas than to myelomas. The case that we report illustrates the difficulty to characterize a heavy chain gammopathy discovered in an elderly woman admitted in the department of internal medicine for alteration of general condition.

In front of the increase of frequentation of emergency departments for pathological situations associated with tetanic risk, and the difficulty to know if the patients are immunized or not, the consequence is an unsuitable consumption of vaccination and/or antitetanic immunoglobulins. At the emergency department of Armentieres's hospital, in a perspective of an accreditation and following a medical request, we wanted to improve patient's care with tetanic risk wound by using a quick test for the detection of specific antitetanic antibodies (tetanos Fumouze test), under laboratory's authority. This test would allow a quickly and reliable immunity evaluation of patients with tetanic risk wound. The use of this point-of-care test was made possible with a good cooperation between clinicians, biologists and nurses. After six months, we wanted to evaluate monitoring and respect for qualities procedures established by laboratory and the medical and cost impact of this test.