41 - Lymphoma and Myeloma Flashcards
may be worth looking at B cell development pathway
first slides on lecture
Ig - features
Glyoprotein molecules produced by plasma cells
Two light and two heavy held by covalent disulphide bonds
One variable and one constant region
How are Ig classified?
Based on aa sequence in constant region of heavy chains: determines IgG,M,A,D,E
Light chain determines kappa or lambda
Protein electrophoreis is…
Lab technique whereby serum is placed in gel and exposed to electric current
5 major fractions in protein electrophoresis
Serum albumin (biggest spike) Alpha-1 globulins Alpha-2 globulins Beta globulins Gamma globulins
From left to right
What happens to the protein electrophoresis in multiple myeloma?
“M-spike” in gamma section
Immunofixation takes place after protein electrophoresis why?
Anti-immunoglobulin antisera is added to each migration lane and if the immunoglobulin is present a complex precipitates
Dyscrasia meaning
an abnormal or disordered state of the body or of a bodily part.
Usually - blood components
What diagnostic criteria is used for myeloma?
IMWG
Primary lymphoid organs
(red) bone marrow and thymus gland
Secondary lymphoid organs
Lymph nodes and spleen
How do most people with myeloma present?
With kidney insufficiency
External factors affecting kidney sufficiency
Renal vein thrombus Bisphosphonates Hypercalcaemia ACEi Dehydration NSAIDs CT contrast Hyperviscosity
AKI with myeloma is what
A MEDICAL EMERGENCY
AKI w/ myeloma treatment
TIME = NEPHRONS
Blood film + electrophoresis + immunofixation + bone marrow biopsy w/ flow cytometry
Treatment with steroids
IMWG diagnostic criteria for myeloma
Serum M-protein
Amyloidosis found by
Renal stain on kidney biopsies where amyloid shows up apple green
Deposit and aggregate in kidneys
What is amyloidosis? + pathogenesis
Amyloid light chain fragments misfold and self-aggregate forming beta-pleated fibrils causing damage into multiple organs
Follicular lymphoma - definition
Neoplastic disorder of lymphoid tissue
Type of non-Hodgkin lymphoma characterised by slowly enlarging lymph nodes
Follicular lymphoma - clinical presentation
Lumps in neck
Follicular lymphoma - % of all non-Hodgkin lymphoma diagnoses
15%
Follicular lymphoma - epidemiology
M=F
Incidence rises with age
Hodgkin Lymphoma - defined by
Presence of Hodgkin Reen-Sternberg cells (HRS) in the presence of cellular infiltrate of non-malignant inflammatory cells
Hodgkin Lymphoma - epidemiology
2.7 per 100,000
Peak in 10s and 20s and then again in 70s
Hodgkin Lymphoma - prognosis
Related to severity of treatment but 86% 5 year survival rate
Hodgkin Lymphoma - treatment
Chemo and radiotherapy
Hodgkin Lymphoma - problems with treatment
Very damaging Increased mortality >20years down the line Pulm toxicity CVD 2° malignancies
