Multiple myeloma Flashcards
What is multiple myeloma
type of cancer that affects plasma cells that are responsible for producing antibodies
arises due to genetic mutations which occur as B -lymphocytes differentiate into mature plasma cells
What is the epidemiology of this disease
rare
median age at presentation is 70 years old
agricultural work
african descent
What is seen on history and examination of someone with multiple myeloma
CRABBI
- calcium
hypercalcaemia - leads to constipation,nausea,anorexia and confusion
-renal
light chain deposition within renal tubules
presents as dehydration and polydipsia
-anaemia
bone marrow crowding suppresses erythropoiesis leading to anaemia
causes fatigue and pallor
-bleeding
bone marrow crowding results in thrombocytopenia which puts patients at increased risk of bleeding and bruising
-bones
lytic bone lesions created from osteoclast overactivity
presents as back pain and increases risk of pathological fractures
- infection
reduction in production of normal immunoglobulins results in increased susceptibility to infection
What investigations are needed
bloods
protein electrophoresis
bone marrow aspiration
imaging
skeletal survey
What bloods are needed
FBC- anaemia
peripheral blood film - rouleaux formation
urea and electrolytes - renal failure
bone profile - hypercalcaemia
What biochemical patterns are usually seen in early stages of myeloma disease
raised calcium
normal/high phosphate
normal alkaline phosphate
What will be seen on protein elctrophoresis
raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
in urine , known as Bence Jones proteins
What is seen on bone marrow aspiration investigation
confirms diagnosis if number of plasma cells is significantly raised (30%)
What imaging is required for multiple myeloma
whole body MRI
X-rays – rain drop skull
What is a rain drop skull
presence of well defined lytic lesions of various size scattered throughout the skull
What is first line of treatment
Bortezomib , lenalidomide or daratumumab – either alone or in combination with other drugs
What are some supportive care measures
bisphosphonate therapy - prevents bone loss
blood transfusions- manage anaemia
kidney dialysis/ transplantation - address kidney damage
What is a complication of multiple myeloma and how does it occur
osteolytic features in multiple myeloma can lead to fractures/ vertebral collapse which compress the spinal cord
What are some features of spinal cord compression
back pain
limb weakness/numbness
urinary/bowel incontinence
How do you diagnose spinal cord compression
whole body x-ray/MRI
How do you manage spinal cord compression
analgesia and surgical decompression
What are red flag symptoms that are associated with back pain
weight loss
no improvement after 2 months
progressive/nocturnal pain
fever
pain at rest
night sweats
morning stiffness
neurological disturbance
sphincter disturbance
history of malignancy
How does a patient with a myeloma usually present
back pain , anemia , hypercalcemia and acute renal failure
How should the hypercalcaemia be managed
Bisphosphonates - hydration required first though
haemodialysis
hydration
start loop diuretics
stop thiazide diuretics
What are potential myeloma-specific causes of renal failure
amyloid
hypercalcaemia
hypercalciuria
light chain deposition
plasma cell deposition
renal stones
