multiple myeloma

Question 1

definition

Answer 1

plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of bone marrow by plasma cells, and the presence of a monoclonal Ig of Ig fragment in serum and/or urine.

usually associated with osteolytic bone disease, anaemia and renal failure

(A haematological cancer characterised by clonal proliferation of plasma cells in the bone marrow, typically associated with a monoclonal component in the serum and/or urine.

The most common presenting features are bone pain and anaemia; the condition may also be identified through investigation of fatigue, infections, hypercalcaemia, or renal impairment.)

Question 2

symptoms (in active symptomatic myeloma)

Answer 2

May be diagnosed incidentally on routine blood tests.
Bone pain: Often in back, ribs. Sudden and severe if caused by pathological fracture or vertebral collapse.
Infections: Often recurrent.
General: Tiredness, thirst, polyuria, nausea, constipation, mental change (resulting from hypercalcaemia).
Hyperviscocity: Bleeding, headaches, visual disturbance.

Question 3

signs

Answer 3

Pallor, tachycardia, flow murmur, signs of heart failure, dehydration. Purpura, hepatosplenomegaly, macroglossia, carpal tunnel syndrome and peripheral
neuropathies.

Question 4

investigations

Answer 4

diagnostic test: serum/urine electrophoresis
=> paraprotein spike (IgG or IgA) and raised light chain urinary excretion

others:

• skeletal survery
• whole body, low dose CT
• bone marrow aspirate and biopsy
• serum clacium
• FBC
• creatinine, urea
• serum beta 2 microglobulin and serum albumin (for prognosis)

Question 5

CRAB in active multiple myeloma

Answer 5

calcium elevated > 2.75 mmol/L
renal insufficiency (creatinine >173 mmol/L)
anaemia (hb <10g/dL)
bone disease

Question 6

risk factors

Answer 6

• MGUS

- abnormal free light chain ratio