2.6 myeloma and other plasma cell disorders Flashcards
2 roles of b-cells
antibody production
antigen presenting cells
monomer immunoglobulins
IgD
IgE
IgG
dimer immunoglobulin
IgA
pentamer immunoglobulin
IgM
b-cell location in the lymph node
follicle geminal centre of the lymph node
what do b-cells do in the lymph node?
antigen fit is improved
may return to marrow as plasma cell or circulate as memory cell = site of transformation
gamma globulins most + or most - by electrophoresis?
gamma globulin sticks next to the negative electrode- (so presumably positively charged) and largest in size
what test do you do to classify the abnormal protein band?
seum immunofixation
how are paraproteins detected?
serum electrophoresis
how is bence jones protein detected?
urine electrophoresis detects these immunoglobulin light chains
single light chain product
kappa light chains
paired light chain product
lambda light chains
what is the effect of IL-6 on osteoblasts and osteoclasts?
inhibits osteoblasts
activates osteoclasts
renal disease in myeloma
tubular cell damage by light gains light chain deposits cast nephropathy sepsis cypercalcaemia, dehydration drugs- nsaids bad amyloid hyperuricaemia
tamm-horsfal proteins
produce casts in myeloma in the thick ascending loop of henle
where does toxic injury occur in the nephron in myeloma?
proximal convoluted tubule
treatment of cast nephropathy?
steroids/chemo
myeloma treatment
steroids: dexamethasone, prednisolone
akylating agents- cyclophosphamide, melphalan
novels: thalidomide, bortezomib, lenalidomide
monitoring of myeloma therapy
paraprotein measurement
MGUS definition
paraprotein
risk of progression of MGUS to myeloma
1% per year
AL amyloidosis
light chain that ppts in tissues as insoluble beta pleated sheet
diagnosis of AL amyloidosis
congo red stain on affected organ = apple green refringenece
-rectal or fat biopsy if high clinical suspicion because its less invasive
IgM paraproteinaemia also known as
waldenstroms macroglobulinaemia
