Multiple Myelomas and Paraproteinaemias Flashcards
Multiple Myeloma definition
Neoplasia of plasma cells of BM production of monoclonal immunoglobulin - paraprotein
IgG is most common
Multiple Myeloma definition
Neoplasia of plasma cells of BM production of monoclonal immunoglobulin - paraprotein
IgG is most common
Incidence of Multiple myeloma
Middle aged to elderly
Increased in afro-carribeans
Clinical Features of Multiple Myeloma
CRAB
Calcium high (thirst, moans, groans, stones, bones)
Renal failure (+ amyloidosis and nephrotic syndrome)
Anaemia (+ pancytopenia)
Bones - pain osteoporsis, osteolytic lesions, fractures
Hyperviscosity sydrome
Investigation of MUltiple Myeloma
Dense narrow band on serum electrophoresis Rouleaux on blood film Bence Jones protein in urine ESR very high >10% plasma cells in BM
Staging system for multiple myeloma
Durie Salmon staging system
Treatment for multiple myeloma
Supportive for CRAB symptoms
Chemo combos: melphalan, Bortezomib (proteasome inhibitor), Lenalidomide, thalidomide
+/- auto SCT or uncommonly allo
Findings in monoclonal gammaglobulinopathy of unknown significance
Findings in smouldering myeloma
> 10% plasma cells (+ >30g/l) in BM but no CRAB ? organ tissue involvement
No Rx required at this stage. Monitor for transformation
Low grade NHL
Lymphoplasmacytoid cells produce monoclonal serum igM that infiltrates LN/BM
Elderly Men
Waldenstrom’s Macroglobinaemia (LPL)
Symptoms of Waldestrom’s Macroglobinaemia
Weight loss, fatigue, hyperviscosity syndrome
visual problems, confusion, CCF, muscle weakness
Treatment of Waldentrom’s Macroglobinaemia
Plasmapheresis for hyperviscoctiy
Chlorambucil, cyclophosphamide and other chemi
Ig light chains - deposition of proteinaceous subst into tissues
Amyloidosis
Diagnosis of amyloidosis
Congo-red stain
Apple green birefringence
Symptoms of amyloidosis
macroglossia, CTS, Peripheral neuropathy, HF, RF
