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IBI Test 3 > B3.043 - Plasma Cell Myeloma > Flashcards

B3.043 - Plasma Cell Myeloma Flashcards

1
Q

how can you tell if a pop of lymphoid cells is clonal? (T and B cells)

A

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)

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2
Q

how do you look at T cell receptors to see if the cells are clonal?

A

look at physical properties

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3
Q

how do you tell if plasma cells are clonal or not?

A

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

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4
Q

are all clonal proliferations neoplastic?

A

no, oligoclonal or transiently clonal proliferations can happen, also can happen in benign cases

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5
Q

plasma cell neoplasms are neoplasms of what type of plasma cells

A

terminally differentiated, immunoglobulin secreting plasma cells

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6
Q

what are important features of plasma cell neoplasms

A

plasma cell proliferation and monoclonal immunoglobulin

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7
Q

what disease is described as a multifocal destructive infiltration of plasma cells in bone marrow

A

plasma cell myeloma (mutiple myeloma)

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8
Q

what is MGUS

A

monoclonal gammopathy of undetermined significance

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9
Q

what do you do when you do with MGUS patients

A

look for markers to see if its evidence of myeloma or not

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10
Q

what is primary amyloidosis

A

deposition of abnormally folded immunoglobunin light chain proteins in beta pleated sheet conformation due to malignancy (its a clonal disorder)

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11
Q

Ig light chain can form what

A

amyloidosis

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12
Q

what is are plasma cell myeloma clinical features? (CRAB criteria)

A

bone pain, fractures, hyperCalcemia
Renal disease
Anemia, thrombocytopenia
Punched out Bone lesions

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13
Q

what are additional clinical features of plasma cell myeloma

A

infections

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14
Q

how do you find monoclonal plasma cells

A

look at blood immunoglobulin composition through electrophoresis

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15
Q

what is rouleaux formation

A

red cells line up behind eachother when theres a lot of protein in blood

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16
Q

how are serum free light chains relevant in plasma cell myelomas

A

if you have a heavy and light chain imbalance due to this some excess lambda or kappa will be present in blood

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17
Q

what do you look for in the urine of patients with plasma cell myeloma

A

Bence Jones protein

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18
Q

what is bence jones protein

A

monoclonal free light chain important in causing renal damage

19
Q

what is your go to test in plasma cell myeloma patients

A

serum protein electrophoresis

20
Q

what shows up as abnormal on electrophoresis

A

large thick bands

21
Q

on electrophoresis what does an increase in polyclonal gamma chains mean

A

non specific
chronic inflammation
liver disease

22
Q

on electrophoresis what does hypogammaglobulinemia mean

A

consider further evaluation for paraprotein

23
Q

what does a monoclonal band mean

A

M protein

24
Q

how much of your total immunoglobulin has to be monoclonal for electrophoresis to pick it up

A

10-20%

25
Q

how does immunofixation electrophoresis work

A

using antibodies to IgG, IgA, IgM, kappy and lambda

26
Q

what is nephelometry

A

used to detect serum free light chains through an antibody designed for the part of the light chain normally not accessible

27
Q

what does a urine study test for

A

detects MFLC aka Bence jones proteins to check for renal failure/disease

28
Q

how do you test for M protein

A

SPE
Serum free light chains
Urinary MFLC/BJP

29
Q

how do you test for bone marrow clonal plasma cells

A

flow cytometry

kappa and lambda immunohistochemistry

30
Q

how do you test for related organ or tissue impairment

A

hypercalcemia
renal insufficiency
anemia
bone lesions

31
Q

what is the threshold for bone marrow monoclonal plasma cells

A

over 10%

nodules or diffues sheets of plasma cells

32
Q

monoclonal plasma cells will show what surface markers

A

CD38+ CD138 +

33
Q

what is the cause of bone pain, fractures, hypercalcemia in plasma cell myeloma

A

ostelytic factors from plasma cells increase osteoclastic activity and decrease osteoblastic activity

34
Q

what causes renal disease in plasma cell myeloma

A 
cast nephropathy
direct tubular toxicity
amyloidosis
light chain deposition in interstitium
hypercalcemia 
hyperuricemia
35
Q

what causes anemia and thrombocytopenia in plasma cell myeloma

A

bone marrow replacement by plasma cells

36
Q

what causes infections in plasma cell myeloma

A

impaired humoral activity

37
Q

how do you treat plasma cell myeloma

A

immunomodulatory agents

38
Q

do plasma cells express CD20

A

no

39
Q

what is the ideal treatment for plasma cell myeloma treatment

A

induction followed by hematopoietic stem cell transplant

40
Q

how is bone disease in plasma cell myeloma treated

A

bisphosphonates

radiation

41
Q

how is hypercalcemia treated

A

hydration

bisphosphonates

42
Q

how is hyperviscosity treated

A

plasmapheresis

43
Q

how is anemia treated

A

transfustions, erythropoietin

IBI Test 3 (16 decks)

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