Multiple Myeloma

Question 1

what is a multiple myeloma

Answer 1

malignancy of the bone marrow (clonal proliferation of plasma cells) causing release of monoclonal antibodies

Question 2

what causes multiple myeloma

Answer 2

occupation exposure to chemical carcinogens, exposure to ionising radiation

evidence for possible post-viral aetiology

Question 3

what mnemonic is used to note the symptoms and clinical features

Answer 3

CRAB HAI

Question 4

clinical features/ presentations of myeloma

Answer 4

Hypercalcaemia

Renal Impairment

Anaemia

Bone pathology- fractures

hyperviscosity

amyloidosis

infection - due to low levels of IgG (hypogammaglobulinaemia)

Question 5

what can hyperviscosity cause/ present with

Answer 5

headaches, bleeding (thrombosis) and visual disturbances

Question 6

when can myeloma be an incidental finding

Answer 6

due to bone pathology, those with myeloma are more prone to fractures and an X-ray may reveal a myeloma

Question 7

what investigations

Answer 7

routine blood work

serum/urine electrophoresis

serum free light chain assay

biopsy (bone marrow aspirate)

Question 8

what level of CRP will you expect

Answer 8

high (the higher it is, the worst the prognosis)

LDH (high)

Beta-2 microglobulin (very high/ very low)

high creatinine and low albumin

Question 9

treatment

Answer 9

conservative or haematopoeitc stem cell transplant

Question 10

additional

Answer 10

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