Myeloma

Question 1

What are the monomer antibody forms?

Answer 1

IgD, IgE and IgG

Question 2

What is the dimer antibody?

Answer 2

IgA

Question 3

What is the pentamer antibody?

Answer 3

IgM

Question 4

Which antibody forms the first part of the immune response?

Answer 4

IgM

Question 5

What is the role of plasma cells?

Answer 5

To produce large quantities of antibodies when needed.

Question 6

What does a polyclonal increase in antibodies suggest?

Answer 6

Reactive aetiology (may be infection, autoimmune, malignancy or liver disease).

Does not suggest an underlying primary bone marrow disorder.

Question 7

What does a monoclonal increase in antibodies suggest?

Answer 7

Suggests an underlying B cell/plasma cell issue.

This is due to clonal expansion occurring from a single B cell - all the products are exactly identical.

Question 8

The monoclonal immunoglobulin responsible in B cell/plasma disorders is called what?

Answer 8

A paraprotein

Question 9

How is the presence of immunoglobulins tested for?

Answer 9

Electrophoresis

Can show the presence of a paraprotein.

Question 10

What are Bence Jones proteins found in?

Answer 10

Urine sample - perform electrophoresis on this.

Question 11

How are Bence Jones proteins produced in?

Answer 11

Kidneys produce free light chains at a rat eof 0.5g/day - when this rate is exceeded, light chains appear in urine.

The presence of these are called Bence Jones proteins.

Question 12

What conditions are associated with Bence Jones proteins?

Answer 12

Multiple myeloma
Waldenstrom’s macroglobulinemia
MGUS

Question 13

What is the most common cause of paraproteins?

Answer 13

MGUS

This is a benign condition.

Question 14

What is myeloma?

Answer 14

A cancer plasma proteins - MGUS is a precursor state to this.

Question 15

How does myeloma harm an individual?

Answer 15

Direct tumor effects

Paraprotein-mediated effects

Question 16

What are direct tumor effects seen in myeloma?

Answer 16

Lytic effects on bone (can cause spinal cord compression)
Raised Ca2+
Pain

Can also have marrow failure.

Question 17

What are paraprotein effects seen in myeloma?

Answer 17

Renal failure
Immunosuppression
Hyperviscosity

Question 18

What is the most commonly involved antibody in myeloma?

Answer 18

IgG

Question 19

What are symptoms of hypercalcaemia?

Answer 19

Stones
Bones 
Groans (abdominal)
Psychiatric overtones
Thirst
Dehydration
Renal impairment

Question 20

How does myeloma cause renal impairment?

Answer 20

Tubular cell damage

Light chain deposition

Question 21

What drug should be avoided in those with myeloma?

Answer 21

NSAIDs - these can cause acute kidney injury.

Question 22

What age group is commonly affected by myeloma?

Answer 22

Over 60s.

Question 23

What can be monitored to show the response of myeloma to treatment?

Answer 23

Paraprotein levels

Question 24

What can be used for symptomatic relief in myeloma?

Answer 24

Strong opiates

Question 25

What can be used to correct hypercalcaemia?

Answer 25

Bisphosphonates

Question 26

How are spinal fractures stabilised?

Answer 26

Vertebroplasty

Question 27

What differs between MGUS and myeloma?

Answer 27

MGUS has a lower paraprotein level, fewer faulty marrow cells, no end organ damage, no bone disease and no recurrent infection.

Question 28

What is Waldenstrom’s macroglobulinemia?

Answer 28

A rare disease, causing lymphoplasmocytoid neoplasia.

Characterised by IgM paraproteins.

Question 29

What is the result of IgM paraproteins presence?

Answer 29

Hyperviscosity syndrome

Question 30

How is Waldenstrom’s macroglobulinemia treated?

Answer 30

Chemotherapy and plasmapheresis