Multiple Myeloma

Question 1

Define multiple myeloma

Answer 1

Haematological malignancy characterised by
proliferation of plasma cells and production of
monoclonal Ig (paraprotein – IgG or IgA)
Associated with:
• Calcium ↑
• Renal failure
• Anaemia
• Bone disease (osteolytic)

Question 2

What are the causes/risk factors of multiple myeloma?

Answer 2

Unknown aetiology
Multiple myeloma cells secrete Ig or Ig fragments into the serum and urine but normal Ig
production is impaired -> hypogammaglobulinaemia -> infection
• Ionising radiation
• Agricultural work
• Occupational chemical exposure e.g. benzene

Question 3

What are the symptoms of multiple myeloma?

Answer 3

• Recurrent infections (10%)

Hypercalcaemia
• Bones – pain in back, ribs
• Groans – fatigue, nausea, constipation
• Thrones – polyuria, polydipsia
• Psychiatric moans – depression

Anaemia (70%)
• Fatigue

Bone disease (osteolytic)
• Bony pain – back, ribs

Hyperviscosity
• Bleeding
• Headaches
• Visual disturbances

Question 4

What are the signs of multiple myeloma?

Answer 4

• Carpal tunnel syndrome
• Peripheral neuropathy

Hypercalcaemia
• Dehydration

Anaemia
• Pallor
• Tachycardia
• High output murmur

Question 5

What investigations are carried out for multiple myeloma?

Answer 5

• Bloods
- FBC – anaemia
- U&Es – renal function, high calcium, phosphate, low PTH
- Normal ALP (myeloma suppresses osteoblasts which produce ALP)
• Serum or urine electrophoresis
- Serum paraprotein (IgG and IgA)
- Urinary Bence-Jones protein (free light chains)
• Skeletal survey/bone scan