Multiple myeloma

Question 1

What might you see in the blood film of a patient with multiple myeloma?

Answer 1

Rouleaux formation

Question 2

What are the features of multiple myeloma?

Answer 2

C alcium (high)
R enal impairment
A naemia
B one pain

Recurrent infections

Question 3

What is the cell type affected in multiple myeloma?

Answer 3

Plasma cells

Question 4

What is the diagnostic test for multiple myeloma?

Answer 4

Serum electrophoresis - M spike
Urine electrophoresis - Bence Jones
Bone marrow biopsy and aspiration

Question 5

What sort of protein in the urine in multiple myeloma?

Answer 5

Bence Jones Protein (Immunoglobulin light chain)

Question 6

What blood tests for suspected multiple myeloma and why?

Answer 6

Calcium and albumin levels - high calcium in multiple myeloma
Urea + Electrolytes - renal impairment in multiple myeloma
FBC - look for anaemia
Immunoglobulin panel - raised Ig light chains (could be kappa)

Urinalysis - looking for casts

Question 7

Give 3 complications of multiple myeloma?

Answer 7

Amyloidosis
Pathological fractures
Hypercalcaemia
Spinal cord compression

Question 8

Treatment for multiple myeloma?

Answer 8

Analgesia - for pain
IV fluids - rehydration and hypercalcaemia
IV Abx
Chemotherapy 
Stem cell transplant