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Haematology > Multiple Myeloma > Flashcards

Multiple Myeloma Flashcards

1
Q

What is multiple myeloma.

A

A malignancy of bone marrow plasma cells resulting in abnormal plasma cells: it increases the levels of monoclonal antibodies.
Due to an abnormal proliferation of a single clone of plasma or lymphoplasmacytic cells leading to the secretion of immunoglobulin (Ig) or Ig fragments, causing the dysfunction of many organs (mainly the kidneys).

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2
Q

What is there an increase of in multiple myeloma.

A

Monoclonal antibodies.

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3
Q

What is the peak age of incidence of multiple myeloma.

A

70.

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4
Q

What are the clinical features of multiple myeloma. (7)

A

Musculoskeletal (bone pain, pathological fractures, vertebral collapse, kyphosis).
Spinal cord compression.
Bone marrow infiltration with plasma cells (anaemia, neutropenia, thrombocytopenia, rarely hyperviscosity).
Respiratory infections.
Anaemia (shortness of breath, palpitations, lethargy).
Headaches and somnolence (due to increased viscosity).
Kidney injury (deposition of light chains in the renal tubules, hypercalcaemia, hyperuricaemia, use of NSAIDs, deposition of AL amyloid).

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5
Q

What are some clinical signs of multiple myeloma. (8)

A

Hyperviscosity: retinal bleeds, bruising, heart failure, cerebral ischaemia.
Amyloid: ‘panda’ eyes, nephrotic syndrome, carpal tunnel syndrome.
Bone pain/fractures.
Lytic lesions.
Renal failure due to: paraprotein deposition, hypercalcaemia, infection, NSAIDs, amyloid.
Spinal cord compression: bony collapse, extradural mass.
Bone marrow: plasmacytosis >30%.
Bence Jones proteinuria.
Abnormal blood tests: anaemia (normo or macrocytic), pancytopenia, raised ESR, hypercalcaemia, renal impairment, paraproteinaemia, immune paresis).

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6
Q

What is seen in a blood film in a patient with multiple myeloma. (2)

A

Leucoerythroblastic.

Rouleaux.

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7
Q

What is seen in an electrophoresis of blood from a patient with multiple myeloma.

A

Monoclonal band.

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8
Q

What is raised in a blood test of a patient with multiple myeloma. (5)

A 
Raised calcium. 
Raised urea.
Raised creatinine. 
Very raised ESR. 
Normocytic normochromic anaemia.
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9
Q

What is found in the urine of a patient with multiple myeloma.

A

Bence-Jones protein.

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10
Q

What is Bence-Jones protein. (2)

A

Immunoglobulin light chains in urine, not picked up on dipstick.

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11
Q

What is the purpose of xrays in a patient with multiple myeloma.

A

To look for lytic lesions.

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12
Q

What are the complications of multiple myeloma. (6)

A 
Amyloidosis. 
Acute renal injury. 
Hypercalcaemia. 
Spinal cord compression (5%).
Bone fractures. 
Hyperviscosity.
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13
Q

What is the median survival rate for a patient with multiple myeloma.

A

3 years.

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14
Q

What is the epidemiology of multiple myeloma.

A

It accounts for 1% of al malignancies.

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15
Q

What are the main monoclonal antibodies produced in multiple myeloma. (3)

A 
Mainly IgG (55%) or IgA (20%). 
Rarely IgM and IgD (2%).
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16
Q

In what percentage of cases of multiple myeloma are no monoclonal antibodies or urine light chains present.

A

Less than 5%.

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17
Q

What is the annual incidence of multiple myeloma.

A

4/100,000.

18
Q

Under what age is multiple myeloma rare.

A

Under 40.

19
Q

In what groups of people is multiple myeloma more common. (2)

A

Men.

Black Africans.

20
Q

In what ethnic group of people is multiple myeloma rare.

A

Asians.

21
Q

What cells are normal plasma cells derived from.

A

B cells.

22
Q

What do normal plasma cells produce. (2)

A

Immunoglobulins which contain heavy and light chains.

23
Q

What are most normal immunoglobulins.

A

Polyclonal.

24
Q

What is a monoclonal immunoglobulin normally referred as.

A

Paraprotein.

25
Q

What are the musculoskeletal features of multiple myeloma. (5)

A 
Bone pain (eg back ache). 
Pathological fractures (long bones, ribs).
Vertebral collapse.
Kyphosis.
Spinal cord compression.
26
Q

What are the bone marrow infiltrative features of multiple myeloma. (4)

A

Anaemia.
Neutropenia.
Thrombocytopenia
Rarely hyperviscosity.

27
Q

What are the features of the Kidney injury features of multiple myeloma. (5)

A 
Due to a variety of features:
Deposition of light chains in the renal tubules.
Hypercalcaemia.
Hyperuricaemia
Use of NSAIDs
Deposition of AL amyloid.
28
Q

Why do patients with multiple myeloma suffer from recurrent respiratory tract infections.

A

Due to the reduction in the normal immunoglobulin levels (immune paresis).
This contributes to the tendency for patients with myeloma to have recurrent infections, particularly of the respiratory tract.

29
Q

Why are the skeletal symptoms in multiple myeloma.

A

There is dysregulation of bone remodelling.
This leads to the typical lytic lesions usually seen in the spine, skull, long bones and ribs.
In myeloma there is increased osteoclast activity with no increased osteoblast formation of bone.

30
Q

What are the symptoms of multiple myeloma. (6)

A

Bone pain (most commonly backache owing to vertebral involvement - 80%).
Anaemia, neutropenia or thrombocytopenia.
Recurrent infections (due to immunoparesis and due to neutropenia - due to chemotherapy and disease).
Symptoms of renal failure (20-30%) (due to light chain deposition).
Symptoms of hypercalcaemia.
Symptoms of hyperviscosity and bleeding due to thrombocytopenia.

31
Q

Where are the majority of the malignant plasma cells found in multiple myeloma.

A

In the bone marrow.

32
Q

What do the malignant pasma cells of multiple myeloma produce.

A

They produce cytokines, which stimulate osteoclasts and result in net bone reabsorption.

33
Q

What is the male:female ratio of multiple myeloma.

A

2:1.

34
Q

What is required to make a diagnosis of multiple myeloma. (3)

A

Two of the following:
Increased malignant plasma cells in the bone marrow.
Serum and/or urinary M proteins.
Skeletal lytic lesions.

35
Q

What is the ratio of African-Caribbean: Caucasians diagnoses with multiple myeloma.

A

2:1.

36
Q

How are the Ig or Ig fragments detected in multiple myeloma. (2)

A

Seen as a monoclonal band (or paraprotein) in serum or urine electrophoresis.

37
Q

What causes the lytic lesions of multiple myeloma seen on xray.

A

Increased osteoclast activity, from signalling by myeloma cells.

38
Q

What investigations should you do on every patient over 50 with back pain. (2)

A

Serum protein electrophoresis.

ESR.

39
Q

What are the consequences of bone marrow infiltration by multiple myeloma. (3)

A

Anaemia.
Bleeding.
Infection.

40
Q

How does multiple myeloma damage the kidneys. (3)

A

Due to light chain deposition - mainly caused by precipitation of light chains with the Tamm-Hors-fall protein in the distal loop of Henle.
Monoclonal immunoglobulins induce changes in the glomeruli.
A rare type of damage is deposits of light chains in the form of AL-amyloid and subsequent nephrosis.

41
Q

What are the typical causes of death in a patient with multiple myeloma. (2)

A

Infection.

Renal failure.

42
Q

What are the symptoms of hyperviscosity. (3)

A

Disturbed vision.
Reduced cognition.
Bleeding.

Haematology (17 decks)

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