Multiple Myeloma

Question 1

Define:

Answer 1

• Haematological malignancy characterised by proliferation of plasma cells resulting in bone lesions and the production of a monoclonal immunoglobulin (paraprotein, usually IgG or IgA)

Question 2

Aetiology/risk factors:

Answer 2

• UNKNOWN
• Possible viral trigger
• Chromosomal aberrations are frequent
• Associated with ionising radiation, agricultural work or occupational chemical exposures

Question 3

Epidemiology:

Answer 3

• Annual incidence: 4/100,000
• Peak incidence: 70 yrs
• Afro-Caribbean > White People > Asians

Question 4

Symptoms:

Answer 4

•	May be an INCIDENTAL finding on routine blood tests 
•	Bone Pain
o	Usually in the back and ribs 
o	Sudden and severe bone pain may be caused by a pathological fracture
o	May get symptoms of hypercalcaemia 
•	Infections - often recurrent bacterial 
•	General
o	Tiredness 
o	Thirst 
o	Polyuria – renal impairment due to light chain deposition 
o	Nausea 
o	Constipation
o	Mental change (due to hypercalcaemia)
•	Hyperviscosity
o	Bleeding 
o	Headaches 
o	Visual disturbance

Question 5

Signs:

Answer 5

CRAB - calcium high, renal impairment, anaemia and bone pain + lesions

• Pallor
• Tachycardia
• Flow murmur
• Signs of heart failure
• Dehydration
• Purpura
• Hepatosplenomegaly
• Macroglossia
• Carpal tunnel syndrome
• Peripheral neuropathies

Question 6

Investigations:

Answer 6

o FBC - low Hb, normochromic normocytic anaemia
o High ESR (and possible high CRP)
o U&Es - high creatinine, high Ca2+
o Normal ALP

Blood Film
o Rouleaux formation with bluish background (suggests high protein)

• Serum or Urine Electrophoresis
o Serum paraprotein
o Bence-Jones protein (monoclonal immunoglobulin light chain that’s found in the urine and suggests multiple myeloma)

Bone Marrow Aspirate and Trephine
o High plasma cells (usually > 20%)

Chest, Pelvic or Vertebral X-Ray
o Osteolytic lesions without surrounding sclerosis e.g. pepper pot skull
o Pathological fractures