Myeloma Flashcards
What are antibodies made up of?
2 heavy and 2 light chains
Which antibody usually exists as a pentamer?
IgM
Which antibody exists as a dimer?
IgA
Which antibodies exist as a monomer?
IgD, IgE, IgG
Which is the most common antibody in the blood?
IgG
Which antibody is passed on in breast milk?
IgA
What are plasma cells?
Cells that produce lots of antibodies and secrete them into your bloodstream
Which cells exhibit an eccentric clock faced nucleus (nucleus over to one side) on staining?
Plasma cell
What does it mean if the patient has a paraproetin?
That they have an underlying clonal B cell disorder
What test do you do to look for paraprotein?
Serum electrophoresis
In what region of the electrophoresis do you look for monocolonal antibodies?
Gamma
After electorphoresis what test do you do to classify the specific antibody that has become multiclonal?
Serum immunofixation
What is normal daily free light chain production?
0.5g per day
If you are producing too many antibody light chains where does the excess go?
Excreted in urine
What is myeloma a cancer of?
Plasma cells
What are the two reasons why m=patients with multiple myeloma get ill?
- Direct tumour cell effects
- Bone lesions
- Increased calcium
- Bone pain
- 2. Paraprotein mediated effects
- Renal failure
Immune suppression
Hyperviscosity
Amyloid
What is the most common type of myeloma?
IgG
What kind of bone lesions do you see in myeloma?
Lytic “punched out” lesions
What cell break down old bone?
Osteoclasts
What cells build bone?
Osteoblasts
What type of bone cells are activated in myeloma?
Osteoclasts
What types of cells are supressed in myeloma?
Osteoblasts
What are the symptoms of hypercalcaemia?
Stones
Bones
Abdominal groans
Psychiatric ,moans
Thirst
Dehydration
Renal impairement
Why do patients with myeloma get kidney damage?
- Tubular cell damage by light chains (more light chains = worse kidney damage)
- Light chain deposition resulting in cast nephropathy.
- Sepsis
- Hypercalcemia and dehydration
- Drugs (NSAIDs) taken for pain
- Amyloid
How do you treat cast nephropathy?
Switch of light chain production with steroids/ chemo
What is the treatment for myeloma?
- Steroids
- Alykylating agents (cyclophosphamide, melphalan)
- Novel agents such as thalidomide
- Monoclonal antibodies
- Stem cell transplants
How do you monitor the response to treatment in myeloma?
Electrophoresis to look at paraprotein level
What drugs would you give in myeloma to correct hypercalcaemia and bone pain?
Bisphosphonates
What is the most common cause of paraproteins?
Monoclonal Gammopathy of Uncertain Significance
What does the paraprotein level have to be to be MGUS?
Less than 30g/l
What is the risk of MGIS turning into myeloma?
Around 1%
What is Amyloid Lightchain Amyloidosis?
Protein deposition is organs tissues. These then interfere with the organ function and cause damage.
What is the structure of AL amyloid in tissue?
Insoluble beta pleated sheet
How do you diagnose AL amyloid?
Biopsy of the affected area and analysis using congo red stain
What is the stain for amyloid?
Congo red
What is lymphoplasmacytoid neoplasm?
Clonal disorder of cells intermediate between a lymphocyte and a plasma cell
What is the paraportein in lymphoplasmacytoid neoplas?
IgM
What are the clinical features of Waldenstrom’s Macroglobulinaemia (IgM paraprotein)
Hyperviscosity syndrome - Fatigue - Bleeding - Confusion B cell symtpoms - Weight loss - Night sweats
What is the treatment of Waldenstrom’s Macroglobulinaemia (IgM paraprotein)
Chemotherapy Plasmapheresis (removed paraprotein from the circulation)
What does plasmaphoresis do in Waldenstrom’s Macroglobulinaemia (IgM paraprotein)?
Removes IgM paraprotein and replace with donor plasma
