06 Plasma cell dyscrasia

Question 0

M proteins

Answer 0

Monoclonal ab in blood and urine 2/2 plasma cell neoplasm

Question 1

Plasma cell morphology

Answer 1

Clock face nuclei and basophilic cytoplasm

Question 2

Bence Jones Proteins

Answer 2

Free light chains in blood and urine 2/2 monoclonal plasma cell neoplasm

Question 3

Multiple myeloma

Answer 3

15% of all heme malignancies in us
50-70 Y.O. , m>f, AA>Caucasians
*Clonal plasma cells
*M protein or Bence Jones Protein in urine or serum
*End organ damage- HyperCalcemia (bone), Renal insuficiency, Anemia, Bone disease

Question 4

Multiple myeloma presentattion

Answer 4

Lytic bone lesions and pathologic fracture
Hypercalcemia
weakness/lethargy-->coma
Polyuria/stones/renal tox (Tubular casts, amyloidosis
Constipation abd pain
depression
arrhythmia
Immunosuppression
Anemia

Question 5

Multiple myeloma prognosis and treatment

Answer 5

Incurable 4-6 year survival

Treatment: Chemo and tandem autologous bone marrow transplants

Question 6

Plasmacytosis

Answer 6

Localized polyclonal B cell tumor
Treated with radiation
80% in upper respiratory tract

Question 7

Lymphoblastic Lymphoma

Answer 7

Plasma cell lymphoma
IgM paraprotein

WALDENSTROMS MACROGLOBULINEMIA

• Hyperviscosity syndrome
• visual and neurologic impairment
• cryoglobulinemia (i.e. raynauds)
• bleeding

Treat: Plasmaphoresis

Question 8

MGUS

Answer 8

Monoclonal gamopathy of undetermined significance
Common monoclonal gammopathy
<10% monoclonal plasmas in BM
NO END ORGAN DMG.

Benign, but 25% transform in 10-20 yrs

Question 9

Amyloidosis

Answer 9

Amyloid protein deposits (misfolded proteins)
CONGO RED-APPLE GREEN BIREFRINGENCE
5-10% due to multiple myeloma