Multiple myeloma Flashcards
Myeloma
Cancer of the plasma cells
Type of B lymphocytes that produce antibodies
Results in large quantities of a single type of antibody
Multiple myeloma
Affects multiple areas of the body
Monoclonal gammopathy of undetermined significance
Excess of single type of antibody without other features of myeloma or cancer
May progress to myeloma
Waldenstrom’s macroglobulinemia
Premalignant
Excessive IgM
Pathophysiology
Antibodies made up of heavy and light chains
Single type of antibody produced by all the identical cancerous plasma cells- monoclonal paraprotein
Bence Jones proteins found in urine (light chains)
Calcium
Hypercalcaemia
Increased osteoclastic bone resorption caused by local cytokine released by the myeloma cells
Common places for myeloma bone disease
Skull
Spine
Long bones
Ribs
Myeloma bone disease
Abnormal metabolism is patchy (osteolytic thin parts)
Lead to pathological fractures
Plasmacytomas
Individual tumours made up of cancerous plasma cells
Occur in bones or in soft tissue
Myeloma renal disease
Light chain deposition within the renal tubules
Causes renal damage
Presents with dehydration and increasing thirst
Anaemia
Bone narrow crowding suppressed erythropoiesis leading to anaemia, neutropenia and thrombocytopenia
Presents with fatigue and pallor
Hyperviscosity
Plasma viscosity increases when there are more proteins in the blood
Leads to easy bruising/ bleeding, reduced or loss of sight due to vascular eye disease, purple discolouration of extremities, heart failure
Risk factors
Older age
Male
Black African ethnicity
Family history
Obesity
Investigations
FBC: anaemia
Peripheral blood film: rouleaux formation
U&Es: renal failure
Bone profile: hypercalcaemia
Urine Bence-Jones protein test
Imaging
Whole MRI to look for bone lesions
Xray- rain drop skill
