308. Myeloma and Paraproteinaemia Flashcards
What is myeloma?
Abnormal proliferation of antibodies leading to secretion of IgG leadign to widespread organ dysnfuction
What organs are affeted myeloma?
Calcium- hypercalcaemia, increased osteoclast activity
Renal impairment- light chain deposition in proximal tubule and loop of Henle
Anaemia- may result from marrow infiltration by plasma cells
B- bone lesions- pathological fractures
B-bacterial infections- due to immunopaeresis
What tests can be done for myeloma?
FBC- normocytic normochromic
Blood film-roloeux
U&E, ESR, Ca, Alk phos,
Serum and or urine electropharesis
Imaging
How do you treat myeloma supportively?
Analgesia for bone pain
Bisphosphonate to reduce fractures
radiotherapy
transfusions and EPO for anaemia
treat infections rapidly with broad spectrum
IV immunoglobulin infusions may be needed
How do you treat myeloma with chemo?
What are the side effects of lenalomide
Induction therapy- lenalomide, bortezombi and dexmethasone
followed up by stem cell transplant
lenalomide side effects- neutropeania, thromboembolism.
What are the complications of myeloma?
Hypercaclcaemia- rehydrate vigorously with saline and use bisphosphonates if required
Spinal cord compression- urgent MRI if suspected, teat with dexmethasone
Hyperviscocity- causes reduced cognition, distrubed vision and bleeding
Acute renal injury- treated with rehydration, urgent dialysis may be needed
What are some differentials for bone pain?
Trauma/fracture
Myeloma/primary malignancies/mets
Osteonecrosis
Hydatid cyst
Osteosclerosis
Paget’s
Sickle cell/Crest
Hyperparathyroidism
Paraproteinaemia is a broad class term for diseases cuases by the proliferation of immunoglobulin produced by a single cell
What are some examples of paraproteinaemia?
Mutiple myeloma
Waldenstroms macroglobinaemia-
Amyloidosis
Monoclonnal gammaopahty of unknown signficance (MGUS)
Heavy chain disease- causes malabsorbtion from intestines. May lead to lymphoma
What is amyloidosis?
Extracellular fibirn that is resistant to degredation.
Can be primary, secondary or familial.
What are the organ systems are affected by primary amyloidosis
Kidneys- Proteinurea and nephrotic syndrome
Heart- restrictive cardiomyopathy, arrythmias
Nerves- peripheral and autonomic neuropathy
Guts- macroglossia, malabsorption, hemorrhage, obstruction
Vascular- purpura, (periorbital)
How is primary amyloidosis treated?
What are the associations with primary amyloidosis?
Optimise nutrition
Melphanan and prednisolone
Stem cell transplant
Associated with myeloma, waldenstroms, lymphoma
Discuss secondary amyloidosis
Reflects chronic inflammation e.g. crohns, RA
Affects Kidneys, liver and spleen
Presents with proteinuria, nephrotic syndrome or hepatosplenomegaly
