Myeloma Flashcards
What are the monomer antibody forms?
IgD, IgE and IgG
What is the dimer antibody?
IgA
What is the pentamer antibody?
IgM
Which antibody forms the first part of the immune response?
IgM
What is the role of plasma cells?
To produce large quantities of antibodies when needed.
What does a polyclonal increase in antibodies suggest?
Reactive aetiology (may be infection, autoimmune, malignancy or liver disease).
Does not suggest an underlying primary bone marrow disorder.
What does a monoclonal increase in antibodies suggest?
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.
The monoclonal immunoglobulin responsible in B cell/plasma disorders is called what?
A paraprotein
How is the presence of immunoglobulins tested for?
Electrophoresis
Can show the presence of a paraprotein.
What are Bence Jones proteins found in?
Urine sample - perform electrophoresis on this.
How are Bence Jones proteins produced in?
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.
What conditions are associated with Bence Jones proteins?
Multiple myeloma
Waldenstrom’s macroglobulinemia
MGUS
What is the most common cause of paraproteins?
MGUS
This is a benign condition.
What is myeloma?
A cancer plasma proteins - MGUS is a precursor state to this.
How does myeloma harm an individual?
Direct tumor effects
Paraprotein-mediated effects
What are direct tumor effects seen in myeloma?
Lytic effects on bone (can cause spinal cord compression)
Raised Ca2+
Pain
Can also have marrow failure.
What are paraprotein effects seen in myeloma?
Renal failure
Immunosuppression
Hyperviscosity
What is the most commonly involved antibody in myeloma?
IgG
What are symptoms of hypercalcaemia?
Stones Bones Groans (abdominal) Psychiatric overtones Thirst Dehydration Renal impairment
How does myeloma cause renal impairment?
Tubular cell damage
Light chain deposition
What drug should be avoided in those with myeloma?
NSAIDs - these can cause acute kidney injury.
What age group is commonly affected by myeloma?
Over 60s.
What can be monitored to show the response of myeloma to treatment?
Paraprotein levels
What can be used for symptomatic relief in myeloma?
Strong opiates
What can be used to correct hypercalcaemia?
Bisphosphonates
How are spinal fractures stabilised?
Vertebroplasty
What differs between MGUS and myeloma?
MGUS has a lower paraprotein level, fewer faulty marrow cells, no end organ damage, no bone disease and no recurrent infection.
What is Waldenstrom’s macroglobulinemia?
A rare disease, causing lymphoplasmocytoid neoplasia.
Characterised by IgM paraproteins.
What is the result of IgM paraproteins presence?
Hyperviscosity syndrome
How is Waldenstrom’s macroglobulinemia treated?
Chemotherapy and plasmapheresis
