Multiple Myeloma signs and symptoms

Question 1

How is a urinalysis carried out on suspected MM patients?

Answer 1

For 24 hours. Using protein electrophoreisis to determine Bence Jones proteinuria and kappa/lambda light chains.

Question 2

What may manifest in patients with renal involvement.

Answer 2

Fanconi syndrome.

Question 3

What are signs of Fanconi syndrome?

Answer 3

Aminoaciduria, hyponatremia, hypoglycaemia associated with glucosuria, low anion gap <5mEq/L, hyperchloremic metabolic acidosis.

Question 4

What does serum protein electrophoreisis identify?

Answer 4

M protein as a narrow ‘spike’ in γ, β or α2 regions of the densitometer tracing.

Question 5

What do ALL secretory myeloma produce?

Answer 5

Excess free light chains.

Question 6

What causes proteinuria?

Answer 6

High level of free light chains

Question 7

What do light chains form on urine electrophoreises?

Answer 7

They form discrete bands.

Question 8

What does immunofixtion determine about free light chains?

Answer 8

Whether the discrete bands are Kappa or Lambda

Question 9

What disorder do patients with Bence Jones protein in their urine have?

Answer 9

Renal failure

Question 10

What deteriorates with MM disease progression?

Answer 10

Renal function.

Question 11

What is usually the presenting symptom of MM?

Answer 11

Renal tube damage and deterioration

Question 12

What is immune paresis?

Answer 12

Suppression of normal immunoglobulin production by malignant plasma clone.

Question 13

What myeloma chain is immune paresis associated with?

Answer 13

Light chain myeloma

Question 14

What is the sign of presence of small serum-free light chains or IgD monoclone?

Answer 14

Low immunoglobulin levels.

Question 15

Why would we carry out immunofixation on samples with not abnormal electrophoteric band shown?

Answer 15

Could be small serum free light chains or IgD monoclones.

Question 16

Where do plasma cells often proliferate?

Answer 16

In bone

Question 17

What causes bone damage in MM?

Answer 17

Breakdown of homeostasis of bone remodelling via osteoclasts and osteoblasts.

Question 18

What forms in the damaged parts of bone?

Answer 18

Circular clones of plasma cells

Question 19

What are osteoclasts and what do they do?

Answer 19

Dissolve bone and this is higher in myeloma patients as there is nothing to regulate this breakdown rate.

Question 20

Define Plasmacytoma?

Answer 20

A single bone lesion

Question 21

What types of bone lesions occur in MM?

Answer 21

Lytic lesions. Osteolytic lesions.

Question 22

Where is MM often found?

Answer 22

In the skull

Question 23

What may be responsible for activating the osteoclast and causing lytic lesions?

Answer 23

Plasma cell release of interlukin 6 IL-6

Question 24

Define Osteoclast?

Answer 24

Large multinucleated cell formed from differentiated macrophage responsible for bone breakdown.

Question 25

What are the three diagnostic criteria of MM?

Answer 25

.Paraprotein in serum/urine
. Over 20% abnormal plasma cells in BM
.Monoclonality of plasma cells (more than 12% with light chain)
.Osteolytic bone lesions

Question 26

Why is presence of paraprotein in serum/urine not a good enough diagnostic aspect on its own?

Answer 26

This symptom can be found in other plasma cell disorders