Multiple Myeloma And Other Paraprotinaemias

Question 1

What is multiple myeloma?

Answer 1

Malignant proliferation of PLASMA CELLS in bone marrow

PRODUCTION OF MONOCLONAL IMMUNOGLOBULIN (PARAPROTEIN)

Question 2

What is a paraprotein?

Answer 2

An immunoglobulin light chain produced in excess by an abnormal monoclonal proliferation of plasma cells.

Question 3

What is seen on serum protein electrophoresis for multiple myeloma?

Answer 3

M spike due to monoclonal immunoglobulin IgG or IgA.

IgG most common.

Question 4

What is found in the urine of patients with multiple myeloma?

Answer 4

Bence-Jones protein

Question 5

Clinical features of multiple myeloma?

Answer 5

CRAB

Calcium high- thirst, moans, groans, stones, bones
Renal failure (plus amyloidosis and nephrotic syndrome)
Anaemia (+pancytopenia)
Bones: pain, osteoporosis, osteolytic lesions, fractures e.g. wedge compression, pepper pot skull

Question 6

What is MGUS?

Answer 6

Isolated M spike with no other features of multiple myeloma.
Small transformation rate no treatment needed.
No CRAB symptoms
Serum monoclonal protein <30g/l
Plasma cells <10% bone marrow

Question 7

What is smouldering myeloma?

Answer 7

Smouldering/asymptomatic myeloma
No CRAB symptoms
IgG/IgA >30g/l or Bence Jones protein
And/or
Clonal bone marrow plasma cells >10%
Higher transformation rate- most will progress to myeloma untreated

Question 8

Findings in multiple myeloma?

Answer 8

Paraprotein >30g/l
Plasma cells in bone marrow >10%
CRAB
Lesions on MRI

Treatment needed

Question 9

Blood film findings of myeyloma?

Answer 9

Rouleaux formation (RBC stacking)

Question 10

Protein deposited in myeloma amyloidosis?

Answer 10

AL