Condition- Multiple Myeloma Flashcards
Define multiple myeloma
Malignant proliferation of plasma cells leading to bone lesions and monoclonal immunoglobulins (IgG, IgA, free light chains)
State the mnemonic used to remember the effects of Multiple Myeloma
CRAB
- Calcium, high: due osteolytic bone lesions
- Renal impairment: light chain deposition in the kidneys + nephrocalcinosis/lithiasis
- Anaemia: due to BM infiltration supressing erythropoiesis
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Bone pain/ lesions: osteoclast activation by myeloma cell signalling
- Also get Bone Marrow Infiltration: Thrombocytopenia + Neutropenia.
List some of the presenting symptoms of Multiple Myeloma
- Hypercalcaemia: polyuria, thirst, confusion, confusion
- Renal Impairment: increased thirst, CKD, Stones
- Anaemia: SOB, dyspnoea, bleeding, bruising, recurrent infections (Other BM cells)
- Bone lesions: bone pain (back and ribs mainly)
- May also get peripheral neuropathy and carpel tunnel syndrome
What would you see in the bloods of someone with Multiple Myeloma
- High Serum IgG and IgA
- C: High serum Ca2+
- R: U+Es: high creatinine (renal impairment)
- A: Low Hb, Low platelets
- B: Normal ALP
What might you see in the blood film of someone with Multiple Myeloma? why?
Roleaux bodies- high proteins makes them adhere (immunoglobulins)
Other than bloods and blood films which investiations would you conduct in someone with MM?
- Urine/ Serum electrophoresis
- Skeletal Survey
- BM aspiration
What is seen in the urine electrophoresis of patients with Multiple Myeloma?
BENCE JONES PROTEINS= Ig Light chains
What would you see in a skeletal suvery of someone with MM?
Osteocytic lesions without associated sclerosis
What result confirms the diagnosis of Multiple Myeloma in a BM aspirate?
monoclonal plasma infiltration >10%
Why is it important to conduct BM aspiration in a patient with suspected MM?
To differentiate MM from monoclonal gammopathy of undetermined significance (which doesn’t present with CRAB)
