Myeloma Flashcards
What is Myeloma?
Cancer of the plasma cells
What does cancer of a specific type of plasma cell result in?
Large quantities of a single type of antibody being produced.
What is multiple myeloma?
Myeloma which affects multiple areas of the body
What is the pneumonic for the presentation of myeloma?
CRABBI
What does CRABBI stand for?
C- Calcium R- Renal A- Anaemia B- Bleeding B- Bones I-Infections
How is the calcium level in myeloma affected?
Hypercalcaemia
What type of anaemia occurs in myeloma?
Normocytic
Normochromic
What is anaemia in myeloma due to?
Bone marrow failure
What type of bone lesions and bone pain is present?
Lytic bone lesions
Pathological fractures
Spinal cord compression
When should you consider myeloma in a patient?
Over 60 with persistent bone pain, particualrly in the back or unexplained pathological fractures
What would be raised in myeloma?
Calcium
ESR
Plasma viscosity
What would be low in someone with myeloma?
Low white cell count
What is the mnemonic for the investigations for myeloma?
BLIP
What does BLIP stand for?
B- Bence-Jones protein (urine)
L- Serum free Light chain assay
I- Serum immunoglobulins
P- Serum protein electrophoresis
What is necessary for the diagnosis of myeloma?
Bone marrow biopsy
What investigation is done to assess for bone lesions?
Whole body MRI
CT if MRI not available
What would you find on an x-ray of someone with myeloma?
Raindrop skull
What is a raindrop skull due to?
Punched out lytic lesions throughout the skull
Is myeloma a curable disease?
No
What is the management of myeloma for?
To control the disease
What type of course does myeloma take?
Relapsing-remitting course
What is the induction therapy for patients who are suitable for autologous stem cell transplantation?
Bortezomib and Dexamethasone
What is the induction therapy for patients who aren’t suitable for autologous stem cell transplantation?
Thalidomide + an Alkylating agent + Dexamethasone
What do patients on thalidomide require?
Venous thromboembolism prophylaxis with aspirin or low molecular weight heparin
What is the management of myeloma bone disease?
Bisphosphonates
Radiotherapy for bone lesions
Orthopaedic surgery for bone fractures
What are some complications of myeloma and the treatment for myeloma?
Infection
Pain
Pathological fractures
What is an effect of the paraprotein?
Amyloidosis
What is amyloidosis?
Group of diseases characterised by deposition of the fibrillar protein
What is the commonest cause of amyloidosis?
Paraprotein or light chain (AL amyloid)
What can the amyloid cause depending on where it forms?
- Nephrotic syndrome
- Cardiac failure
- Carpal tunnel syndrome
- Autonomic neuropathy
- Cutaneous infiltration
What is the commonest type of myeloma?
IgG myeloma
What might you see on a peripheral blood film in someone with multiple myeloma?
Rouleaux formation
What would you see with protein electrophoresis in someone with multiple myeloma?
raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
in the urine, they are known as Bence Jones proteins
Wat would you find in a bone marrow aspiration in someone with multiple myeloma?
Significant increase in plasma cells
What is the now the recommended imaging used in multiple myeloma?
Whole-body MRI
