2: Myeloma Flashcards
What is myeloma
Uncontrolled proliferation of plasma cells leading to Ig secretion
What does classification of myeloma depend on
Ig secreted
In which gender is myeloma more common
Males (3:2)
What age is the peak incidence of myeloma
50-70 years-old
What ethnicity is myeloma more common
Afro-Carribean
What is monoclonal gammopathy of unknown signficiance
Where there are plasma cells releasing abnormal antibody, however, levels are significantly less compared to myeloma
What % of plasma cells are normal in MGUS
3%
What % patients with MGUS will develop myeloma
10%
What is a common first presentation in myeloma
Back Pain
What causes back pain in myeloma
Osteolytic lesions - causing pathological fractures and vertebral collapse
What can osteolytic bone lesions cause
Fractures
What is a mnemonic to remember symptoms of myeloma
CRABBI
What does CRABBI stand for
Calcium High Renal Failure Anaemia Bone fractures Bleeding Infection
What are the symptoms of hypercalcaemia
Stones, Bones, Groans and Psychic Overtones
What are the renal signs of myeloma
Renal: dehydration and first
How may anaemia present in myeloma
Breathlessness, Pallour, Fatigue
What causes bleeding in myeloma
Thrombocytopenia
How does thrombocytopenia in myeloma manifest
Bleeding and bruising
What are bone symptoms in multiple myeloma
Osteolytic lesions and fractures
Why is infection more common in multiple myeloma
As monoclonal gammopathy leads to decrease functional Ig - predisposing to infection
Explain initial pathophysiology of multiple myeloma
- There is a shift from haematopoietic stem cells to produce plasma cells which produce Ig (light-chains only)
- These light chains may enter kidney to cause renal failure
Explain relationship between multiple myeloma and osteoblasts
Multiple myeloma secrete IL3 which inhibits production osteoblasts
Explain relationship between multiple myeloma and osteoclasts
Multiple myeloma cells have RANKL that stimulate osteoclasts
How does multiple myeloma cause anaemia
- Increases haematopoietic stems cells used to produce lymphoid cells (B-cells) decrease those available to produce RBC
- Causes renal failure, impeding EPO secretion
- Over-production plasma cells in bone marrow reduces area and nutrients to produce other cells
when is multiple myeloma suspected
Over 60 year-old with persistent bone pain or unexplained fracture
what is basic blood tests should be ordered in multiple myeloma
FBC
ESR
Bone Profile
U+E
what will be seen on FBC
- Anaemia
- Thrombocytopenia
what will be seen on Bone Profile
- High calcium
- Normal ALP
If an over-60 year-old with high calcium what tests should be ordered in 48 hours
Serum electrophoresis
Bence-Jones Proteins
What will be seen on peripheral blood film in multiple myeloma
Rouleaux cells
What are rouleaux cells
Aggregated RBC
why are U+E ordered
Myeloma can cause renal failure
If individual has bone pain what should be ordered
X-Ray bone
What may be seen in myeloma
Raindrop skull = multiple osteolytic lesions of the skill
What needs to be ordered to confirm myeloma
Trephine bone-marrow biopsy
What will be seen on trephine biopsy in multiple myeloma
> 10% plasma cells
What is the gold-standard to view extent of multiple myeloma disease
MRI
When do individuals with myeloma require urgent referral to secondary care
Calcium >2.9
If calcium below 2.9, when should individuals be referred
2W referral to haematologist
in multiple myeloma how often are patients reviewed
3-months
what supportive measures are given for myeloma
- NSAIDs: pain
- Bisphosphonates and Radiotherapy: Bony Lesions
- Epo: for anaemia
- Broad spectrum antibiotics
What is used to treat multiple myeloma in young individuals
Autologous stem cell transplant
What is autologous stem cell transplant
- Stem cells taken from individual
- Then, high dose chemotherapy used to irradiate bone marrow
- Stem cells re-introduced
If individual is not suitable for autologous stem cell transplant what is done
High-dose chemotherapy agents
