B3.043 - Plasma Cell Myeloma Flashcards
how can you tell if a pop of lymphoid cells is clonal? (T and B cells)
look at ratio of kappa and lambda chains for B lymphocytes
For T lymphocytes you have to look at epitope (4 chains in T cell receptor)
how do you look at T cell receptors to see if the cells are clonal?
look at physical properties
how do you tell if plasma cells are clonal or not?
look at lambda and kappa chains on surface of B cells, a significant preference of one or the other is not normal
or
look at Igs and see if theres a lot of diversity, if no then not normal
are all clonal proliferations neoplastic?
no, oligoclonal or transiently clonal proliferations can happen, also can happen in benign cases
plasma cell neoplasms are neoplasms of what type of plasma cells
terminally differentiated, immunoglobulin secreting plasma cells
what are important features of plasma cell neoplasms
plasma cell proliferation and monoclonal immunoglobulin
what disease is described as a multifocal destructive infiltration of plasma cells in bone marrow
plasma cell myeloma (mutiple myeloma)
what is MGUS
monoclonal gammopathy of undetermined significance
what do you do when you do with MGUS patients
look for markers to see if its evidence of myeloma or not
what is primary amyloidosis
deposition of abnormally folded immunoglobunin light chain proteins in beta pleated sheet conformation due to malignancy (its a clonal disorder)
Ig light chain can form what
amyloidosis
what is are plasma cell myeloma clinical features? (CRAB criteria)
bone pain, fractures, hyperCalcemia
Renal disease
Anemia, thrombocytopenia
Punched out Bone lesions
what are additional clinical features of plasma cell myeloma
infections
how do you find monoclonal plasma cells
look at blood immunoglobulin composition through electrophoresis
what is rouleaux formation
red cells line up behind eachother when theres a lot of protein in blood
how are serum free light chains relevant in plasma cell myelomas
if you have a heavy and light chain imbalance due to this some excess lambda or kappa will be present in blood
what do you look for in the urine of patients with plasma cell myeloma
Bence Jones protein
what is bence jones protein
monoclonal free light chain important in causing renal damage
what is your go to test in plasma cell myeloma patients
serum protein electrophoresis
what shows up as abnormal on electrophoresis
large thick bands
on electrophoresis what does an increase in polyclonal gamma chains mean
non specific
chronic inflammation
liver disease
on electrophoresis what does hypogammaglobulinemia mean
consider further evaluation for paraprotein
what does a monoclonal band mean
M protein
how much of your total immunoglobulin has to be monoclonal for electrophoresis to pick it up
10-20%
