Multiple Myeloma

Question 1

Definition

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

Presenting symptoms (general)

Answer 4

o Tiredness
o Thirst
o Polyuria
o Nausea
o Constipation
o Mental change (due to hypercalcaemia)

Question 5

Presenting symptoms (more specific)

Answer 5

· 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

· Infections - often recurrent

· Hyperviscosity
o Bleeding
o Headaches
o Visual disturbance

Question 6

Signs on physical examination

Answer 6

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

Question 7

Investigations (blood)

Answer 7

· Bloods
o FBC - low Hb, normochromic normocytic
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)

Question 8

Investigations (other)

Answer 8

· 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
o Pathological fractures