Haematology- Myeloma and Paraproteins

Question 1

Okay to start, antibodies are the same thing as immunoglobulins…

Answer 1

Yeah

Question 2

Which cells produce antibodies/immunoglobulins?

Answer 2

B cells

Question 3

Structure of an immunoglobulin?

Answer 3

Y shaped
2 light chains
2 heavy chains

Question 4

What are the five types of heavy chains in immunoglobulins?

Answer 4

IgG
IgA
IgM
IgE
IgD

Question 5

What is the first immunoglobulin produced in reactions?

Answer 5

IgM

Question 6

What are IgA immunoglobulins used in?

Answer 6

To assess mucous membrane immunity e.g. seen in coeliac disease

Question 7

Lights chains can be one of two types. What are they?

Answer 7

Kappa or Lambda

->random chance which is produced

Question 8

Normal IgG levels?

Answer 8

6-15g/L

->can be elevated in colds, flu, etc. but highly elevated means something more serious basically.
He saw someone in clinic this morning with a IgG of 95g/L so that’s suggestive of myeloma apparently

Question 9

Normal IgA count?

Answer 9

1-4.5g/L

Question 10

Normal IgM count?

Answer 10

0.5-2g/L

Question 11

What is a paraprotein?

Answer 11

Monoclonal immunoglobulin present in blood or urine

->If present, it tells us that there is monoclonal proliferation of a B lymphocyte / plasma cell somewhere in the body

Question 12

What does serum protein electrophoresis separate proteins by?

Answer 12

Based on size and charge

Question 13

What is immunofixation?

Answer 13

Identifies the class of paraprotein present e.g. IgA, IgA

Question 14

In lymphoma, which paraprotein would you expect to see?

Answer 14

IgM

Question 15

In myeloma, which paraprotein would you see

Answer 15

IgG, IgA

Question 16

Features of myeloma?

Answer 16

Bone disease
Bone marrow failure esp. anaemia
Infections

CRAB- hyperCalcaemia, Renal failure, Anaemia, Bone disease

Question 17

How is a diagnosis of myeloma made?

Answer 17

Excess plasma cells in the bone marrow, must comprise >10% of total bone marrow cell population

->paraproteins are common, vast majority have nothing wrong with them.

Question 19

Which paraprotein is most commonly seen in myeloma?

Answer 19

IgG- 55%
IgA- 21%

Question 20

Treatment of myeloma?

Answer 20

Chemo: proteasome inhibitors, monoclonal antibodies
Bisphosphonate therapy- for associated bone disease, nothing to myeloma
Radiotherapy
Steroids
Surgery- pinning of long bones, decompression of spinal cord
Autologous stem cell transplant

Question 21

IgM myeloma does not exist!

What are IgM paraproteins are associated with?

Answer 21

Low-grade lymphomas

Question 22

When requesting lab tests for possible multiple myeloma, which of the following is the single most useful test?

1 – Serum total protein
2 – Serum immunoglobulins
3- Serum total electropheresis
4- ESR

Answer 22

3- Serum total electrophoresis

->tells you if there is a paraprotein

Question 23

Which of the following are not associated with a paraprotein?
1 ) Amyloidosis
2) Waldenstrom’s macroglobulinaemia
3) Melanoma
4) MGUS

Answer 23

3- melanoma

Question 24

Which of the following are true about monoclonal gammopathy of uncertain significance (MGUS
1) Most people will not require monitoring
2) The incidence is higher than myeloma
3) Approximately 50% will have lytic bone disease, anaemia, hypercalcaemia or renal failure
4) Only people with an IgD and IgE MGUS require monitoring

Answer 24

2

->1 is also kind of right

Question 25

A 72yo woman presents with back pain. Her MRI is normal
Her FBC, calcium and renal function are normal
She has an IgG paraprotein of 7g/l. IgA and IgM levels are normal
Her bone marrow shows 12% plasma cells

What is the most likely diagnosis?
1. IgG MGUS
2. Symptomatic myeloma
3. Assymptomatic myeloma
4. Lymphoplasmacytic lymphoma

Answer 25

3