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Immunoproliferative Disorders > Clinical findings of MM > Flashcards

Clinical findings of MM Flashcards

1
Q

What causes a decreased production of normal blood cells in MM?

A

Infiltration of the bone marrow

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2
Q

What is a clinical finding of MM related to bone lesions?

A

Bone pain. Fractures, Vertebral collapse. Hypercalcaemia. Oseoporosis.

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3
Q

What are bone pain and fractures associated with in MM?

A

Bone lesions.

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4
Q

What are clinical findings related to the decrease production of normal blood cells in MM?

A

Anaemia fatigue, lethargy, dyspnoea. Thrombocytopenia-increased bleeding. Leukopenia-increased infection rate.

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5
Q

Where do symptoms of myeloma show for patients?

A

Often related to the organ system most affected e.g. renal/anaemia/bone pain.

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6
Q

What is the result of malignant plasma cells replacing Bm cells?

A

Decrease in production of normal cells.

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7
Q

What percentage of bone marrow cells can be replaced by malignant plasma cells?

A

More than 30%

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8
Q

Why do MM patients have recurrent infections?

A

Immunosuppressive effect of malignancy and proliferation of one cell (monoclonal or M protein).

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9
Q

What causes spinal cord compression in 20% of patients?

A

Vertebral collapse or tumour growth adjacent to spinal cord.

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10
Q

How does loss of bone lead to renal failure/drowsiness?

A

Bone loss results in high plasma calcium levels (hypercalcaemia)

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11
Q

What is the normal blood calcium range?

A

8.5 to 10.5 mg/dl

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12
Q

What causes serum hyperviscosity?

A

High concentrations of Ig in the serum

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13
Q

What is serum hyperviscosity?

A

Increased thickness due to increased protein conc.

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14
Q

Why does plasma volume increase in response to serum hyperviscosity?

A

In an aim to reduce this.

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15
Q

Which cells are negatively impacted by an increase in plasma volume?

A

RBC’s, Leucocytes, Platelets.

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16
Q

What does the reduction in RBC, Leucocytes and Platelets cause?

A

Worsening of anaemia, leukopenia, thrombocytopenia due to BM damage.

17
Q

What can increased serum viscosity lead to?

A

Platelet abnormalities. Poor perfusion (passage of blood through vessels).

18
Q

What are reasons for MM patients and impaired immunity?

A

Reduced WBC count. Large amount of a monoclonal antibody due to large plasma cells which reduced normal polyclonal Ig concentraation.

19
Q

What can high protein plasma concentration and high calcium in kidneys cause?

A

Kidney damage resulting in RENAL FAILURE.

20
Q

When might bence-jones be detected in the blood?

A

Renal failure that leads to a reduction in bence-jones products excreted in blood.

21
Q

What might be expected to happen to patients with significant glomerular damage?

A

Leakage of ALL serum proteins into urine INCLUDING paraprotein.

22
Q

What is normocytic anaemia?

A

Anaemia where erythrocytes are normal in size.

23
Q

What is macrocytic anaemia?

A

Enlarged RBC’s. (Folic acid deficiency is 1 cause)

24
Q

What 6 types of lab investigations are used for MM?

A

.Complete blood count
.Peripheral blood film
.Bone Marrow biopsy
.Serum protein electrophoresis
.Immunofixation Electrophoresis
.Cytogenetics

25
Q

Why so blood films show roluleaux formation-red cells stacking?

A

Caused by high paraprotein conc

26
Q

What is seen in a complete blood count and differential?

A

Anaemia (normo/macro). Thrombocytopenia. Increased erythrocyte sedimentation rate (ESR)

27
Q

What causes ESR?

A

Increased paraprotein conc.

28
Q

What is seen in a peripheral blood film?

A

Rouleaux formation. Sometimes low numbers of neoplastic plasma cells.

29
Q

How many plasma cells are usually seen through a bone marrow biopsy?

A

10-90%

30
Q

Why do MM patients have very high serum Ig levels?

A

Because plasma cells are involved in Ab production.

31
Q

Do MM patients have an increase of decrease in normal immunoglobulin levels?

A

Decrease

32
Q

How are Ig concentrations determined?

A

Turbidimetry (measuring through cloudiness). Nephelometry (estimating cell/particle amount in suspension via light). Radial immunodiffusion (used in smaller labs).

33
Q

Why ae radial diffusion or ELISA oftened used to measure Ig levels?

A

Low levels of IgD in serum.

34
Q

What is IgE measured by?

A

ELISA.

35
Q

What forms so that it can be measured by nephelometry/turbidimetry assays?

A

Immune complex lattice formation

Immunoproliferative Disorders (5 decks)

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