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3MB Haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

Define plasma cell

A

B lymphocytes that produce antibodies

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2
Q

Cancer in a specific type of plasma cell results in the production of..

A

Specific paraprotein (or M protein)

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3
Q

What is Monoclonal gammopathy of undetermined significance (MGUS)?

A

Production of a specific paraprotein without other features of myeloma or cancer

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4
Q

Define smouldering myeloma

A

Abnormal plasma cells and paraproteins but no organ damage or symptoms

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5
Q

Define Bence Jones protein

A

Free light chains in the urine

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6
Q

Four key symptoms of myeloma

A

C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain

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7
Q

What is the most common complication of myeloma?

A

Anaemia - cancerous plasma cells invade the bone marrow resulting in suppression of the other blood cell lines

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8
Q

Describe the type of anaemia that occurs in myeloma

A

Normocytic normochromic

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9
Q

What is myeloma bone disease?

A

Increased osteoclast activity and suppressed osteoblast activity. Caused by cytokines released from abnormal plasma cells and other nearby cells

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10
Q

Common sites of myeloma bone disease are..

A

Skull, spine, long bones and ribs

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11
Q

The abnormal bone metabolism is patchy, meaning..

A

Bone becomes very thin in some areas while others remain relatively normal

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12
Q

Patches of thin bone are described as..

A

Osteolytic lesions

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13
Q

Weak points in the bone lead to __________ under minimum force

A

Pathological fractures

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14
Q

Increased osteoclast activity causes calcium reabsorption from the bone into the blood, resulting in..

A

Hypercalcaemia

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15
Q

What are Plasmacytomas?

A

Individual tumours formed by cancerous plasma cells

They can occur in the bones, replacing normal bone tissue, or in the soft tissues

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16
Q

Patients with myeloma often develop renal impairment. What can cause this?

A

Paraproteins
Hypercalcaemia
Dehydration
Glomerulonephritis
Medications used to treat the condition

17
Q

What is the normal viscosity in blood flow?

A

Between 1.3 and 1.7 times of water (blood is thicker than water)

18
Q

Plasma viscosity increases when..

A

There are more proteins are in the blood, such as the paraproteins found in myeloma

19
Q

Hyperviscosity syndrome is considered an emergency. It can cause many issues such as..

A

Bleeding (e.g., nosebleeds and bleeding gums)
Visual symptoms and eye changes (e.g., retinal haemorrhages)
Neurological complications (e.g., stroke)
Heart failure

20
Q

Risk factors for Hyperviscosity Syndrome

A

Older age
Male
Black ethnic origin
Family history
Obesity

21
Q

Ix for myeloma

A

Bloods
Protein electrophoresis
Bone marrow aspiration
Whole-body MRI/X-rays

22
Q

What type of blood tests are done into myeloma?

A

FBC: anaemia
Peripheral blood film: rouleaux formation
Urea and electrolytes: renal failure
Bone profile: hypercalcaemia

23
Q

Protein electrophoresis results that would indicate myeloma

A

Bence Jones proteins - raised concentrations of monoclonal IgA/IgG proteins

24
Q

Bone marrow aspiration confirms the diagnosis of myeloma if the number of ________ is significantly raised

A

Plasma cells

25
Q

What does the x-ray show?

A

‘Rain-drop skull’ seen in myeloma

26
Q

What would be a differential for rain drop skull seen in myeloma?

A

‘Pepperpot skull’ seen in primary hyperparathyroidism

27
Q

Diagnostic criteria for myeloma

A

One major and one minor criteria or three minor criteria if has signs or symptoms of multiple myeloma

28
Q

Major criteria for myeloma

A

Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine

29
Q

Minor criteria for myeloma

A

10% to 30% plasma cells in a bone marrow sample
Minor elevations in the level of M protein in the blood or urine
Osteolytic lesions
Low levels of antibodies (not produced by the cancer cells)

30
Q

Define myeloma

A

Plasma cell proliferation due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells

31
Q

Tx for myeloma

A

Combination of chemotherapy:

Bortezomib (a proteasome inhibitor)
Thalidomide
Dexamethasone

32
Q

High-dose chemotherapy followed by a stem cell transplant is an option for fitter patients and may achieve a more extended period of remission. Stem cell transplantation can be..

A

Autologous (using the person’s own stem cells)
Allogeneic (using stem cells from a healthy donor)

3MB Haematology (23 decks)

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