MM + Paraproteinaemias

Question 1

Any plasma cells on BM
CRAB
Any paraprotein

Answer 1

MM

As soon as there is any sign of CRAB symptoms it is MM

Question 2

Paraprotein >30
Plasma cells in BM >10%
No CRAB

Answer 2

Smouldering

Question 3

Blood results MM

Answer 3

High calcium
Raised ESR
Normal ALP

Question 4

Distinguishing factor MM vs. other malignancies

Answer 4

Normal ALP

Question 5

Paraprotein <30
Plasma cells in BM <10%
No CRAB

Answer 5

MGUS

Question 6

CRAB

Answer 6

High calcium (osteoclasts)
Renal impairment (Ig accumulates in kidneys)
Anaemia + BM failure (plasma cells infiltrate)
Bone lytic lesions (osteoclasts break down - pepper pot skull)

Question 7

Dense monoclonal narrow gamma-globulin band with sharp M peak
Kappa OR lambda light chains
Rouleaux on blood film
Bence-Jones protein
High ESR

Answer 7

Multiple myeloma

Question 8

Immunophenotype plasma cells

Answer 8

CD138+ CD19-

Question 9

MM staging system

Answer 9

Durie-Salmon

Question 10

Plasmacytic vs. plasmablastic MM

Answer 10

Plasmablastic less mature - reticular chromatin, prominent nucleolei, less cytoplasm

Question 11

Tx for MM

Answer 11

For CRAB - bisphosphonates

For cure - Auto-SCT after melphalan to wipe out, proteasome inhibitors (e.g. bortezomib), thalidomide

Question 12

Elderly man
Monoclonal serum IgM
Type of low-grade NHL
Hyperviscosity - blurred vision

Answer 12

Waldenstrom’s Macroglobinaemia

Question 13

Apple green birefringence

Answer 13

Amyloidosis

Question 14

Other paraproteinaemias

Answer 14

Waldenstrom’s

Amyloidosis

Question 15

Most common Ig in MM

Answer 15

IgG > IgA > IgD