haem Flashcards
What are the criteria smouldering myeloma?
paraprotein >30g/l
>10% plasma cells in BM
no related organ or tissue impairment
doesn’t require treatment, monitoring needed
What is MGUS?
monoclonal gammopathy of unknown significance
a premalignant condition that makes paraprotein
increases risk of myeloma and lymphoma
What can come before multiple myeloma?
MGUS
Smouldering myeloma
all plasma cell dyscrasias
Do you treat MGUS and smouldering myeloma?
Not yet
Just monitor
What is the risk of MGUS and smouldering myeloma progressing to multiple myeloma?
MGUS: 1%
SM: 20% in first year, then 5%
What is the criteria for MGUS?
Paraprotein <30 g/L.
Monoclonal plasma cells in bone marrow <10%.
Absence of myeloma-related organ or tissue impairment
What investigations would be carried out for multiple myeloma?
FBC (anaemia or leukopenia in myeloma)
Calcium (raised in myeloma)
ESR (increased in myeloma)
Plasma viscosity (increased in myeloma)
U&E (for renal impairment)
Serum protein electrophoresis (to detect paraprotein)
Serum-free light-chain assay (to detect abnormally abundant light chains)
Urine protein electrophoresis (to detect the Bence-Jones protein)
What are the main presentations in multiple myeloma?
C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain
What are the symptoms of multiple myeloma?
Persistent bone pain and pathological fractures
Unexplained fatigue and weight loss
Fever of unknown origin
Hypercalcaemia
Anaemia
Renal impairment
Dizziness, confusion, blurred vision, headaches, epistaxis, cerebrovascular event
What is myeloma?
a type of cancer affecting the plasma cells (differentiated B lymphocytes) in the bone marrow.
Leads to accumulation of malignant plasma cells
proliferation disorder of plasma cells
What is multiple myeloma?
myeloma affecting multiple bone marrows in the body
What are some differentials for multiple myeloma?
MGUS
Amyloid light-chain (AL) amyloidosis.
Solitary plasmacytoma.
B-cell non-Hodgkin’s lymphoma
Chronic lymphocytic leukaemia
Examples of triplet drug combos for initial therapy in multiple myeloma
- VTD: Bortezomib, thalidomide, and dexamethasone
- KRD: carfilzomib, lenalidomide and dexamethasone
- RVD: lenalidomide, bortezomib and dexamethasone
What does allogeneic stem cell transplant mean?
stem cells from a healthy donor
What are autologous stem cells?
derived from the patient
Treatment for healthy patients, patients younger than 65-70, with multiple myeloma
Induction drug therapy
Stem cell transplant
Possible complications of multiple myeloma
Infection
Bone pain and fractures
Renal failure
Anaemia
Hypercalcaemia
Peripheral neuropathy
Hyperviscosity syndrome
Venous thromboembolism
What is lymphoma?
malignancies of the lymphoid system
disease may arise at any site where lymphoid tissue is present
What is anaemia?
haemoglobin <130 g/Lin men aged ≥15 years
<120 g/L in non-pregnant women aged ≥15 years
<110 g/L (11 g/dL) in pregnant women
What can cause a decreased production of RBCs?
Iron, folate and B12 deficiencies
Bone marrow failure
What can cause RBC loss?
Bleeding
Haemolysis
What is the most common cause of anaemia worldwide?
Iron deficiency
What is the aetiology of iron def anaemia?
Inadequate iron intake
Impaired iron absorption
Blood loss
Increased need (e.g. growth in children)
What helps to absorb B12?
Intrinsic factor
B12 must bind to IF to be absorbed in terminal ileum