Multiple Myeloma Flashcards
What is myeloma?
Cancer of the plasma cells
B lymphocyte that produce antibodies
What is multiple myeloma?
Myeloma affecting multiple areas of the body
Anaemia in myeloma
Cancerous cells invade the bone marrow = bone marrow infiltration
Suppression of development of other blood cell lines
FBC results in multiple myeloma
Anaemia (low red cells)
Neutropenia (low neutrophils)
Thrombocytopenia (low platelets)
Bone disease in myeloma
Weakness in skull, spine, long bones and ribs
Osteolytic lesions prone to pathological fractures
Hypercalcaemia
Renal disease in myeloma
High levels of immunoglobulins can block the flow through the tubules
Hypercalcaemia impairs renal function
Dehydration
Medications used to treat the conditions such as bisphosphonates can be harmful to the kidneys
Four features of myeloma
CRAB
Calcium (elevated)
Renal failure
Anaemia (normocytic, normochromic)
Bone lesions/pain
Risk factors for myeloma
Older age
Male
Black African ethnicity
Family history
Obesity
Investigations in myeloma
BLIP
B- Bence-Jones protein (urine electrophoresis)
L- Serum-free Light chain-assay
I- Serum Immunoglobulins
P - Serum Protein electrophoresis
Bone marrow biopsy requested for definitive diagnosis
Imagine for myeloma
To assess for bone lesions
Whole body MRI/CT
Skeletal survey
Xray signs in myeloma
Punched out lesions
Lytic lesions
“Raindrop skull” caused by many punched out (lytic) lesions throughout the skull that give the appearance of raindrops splashing on a surface
Management of myeloma
Chemotherapy
Stem cell transplantation
VTE prophylaxis
Management of myeloma bone disease
Bisphosphonates (suppress osteoclast activity)
Radiotherapy to bone lesions can improve bone pain
Surgery to stabilise bones (e.g. by inserting a prophylactic intramedullary rod) or treat fractures
Cement augmentation involves injecting cement into vertebral fractures or lesions and can improve spine stability and pain
Complications of myeloma
Infection
Pain
Renal failure
Anaemia
Hypercalcaemia
Peripheral neuropathy
Spinal cord compression
Hyperviscocity
Features of multiple myeloma
CRAB
Hypercalcaemia
Renal insufficiency
Anaemia
Bone pain
