Haem P2

Question 1

Myeloma

Answer 1

malignant proliferation of plasma cells

Question 2

Myeloma patho

Answer 2

produces diffuse BM infiltration -> bone destruction, BM failure

overproduction of ABs

sub-classified by type of AB they produce - IgG myeloma most common

malignant plasma cells produce excess of one type of Ig - other Ig levels are low - susceptible to infection

Question 3

Myeloma Px

Answer 3

OLD - old age
C - calcium elevated
R - renal failure (results in thirst due to water loss)
A - anaemia (infection, bleeding, fatigue, pallor)
B - bone lytic lesions (back pain) - malignant plasma cells release factors which activate osteoclasts, inhibit osteoblasts

Question 4

Myeloma DDx

Answer 4

bone pain ddx - trauma, fracture, osteomyelitis, osteosclerosis, Paget’s, SCA, renal osteodystrophy, CREST/Sjogren’s, hyperparathyroidism

Question 5

Myeloma Ix

Answer 5

FBC - anaemia, raised ESR, Rouleaux formation on blood film (stacks/aggregation of RBCs)

BM biopsy

U+E - high calcium, urea, creatinine, ALP

Bence-jones protein in urine

X-ray - lytic punched-out lesions in long bones, fractures, osteoporosis, pepperpot skull

CT/MRI

Serum and urine electrophoresis - shows type of paraprotein (Ig) - monoclonal band

Question 6

Myeloma Mx

Answer 6

analgesia for bone pain
bisphosphonates
local radiotherapy
IV Ig infusion
Transfusion to correct anaemia
Renal dialysis
Infections - ABs
Chemo

Question 7

Myeloma Cx

Answer 7

Hypercalcaemia, spinal cord compression, acute renal injury