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Y3 Haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

what three tests can be used to assess immunoglobulins?

A

serum immunoglobulin levels
electrophoresis and immunofixation
serum light chain levels (urine bence jones protein)

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2
Q

what does the term paraprotein mean?

A

monoclonal immunoglobulin present in urine or blood

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3
Q

what part of the immunoglobulin does serum immunoglobulins levels look at?

A

Fc portion of immunoglobulin

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4
Q

what is the function of electrophoresis?

A

separates protein based on charge and size

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5
Q

what does serum light chain levels detect?

A

excess of light chains

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6
Q

what does immunofixation do after electrophoresis?

A

determines subtype of immunoglobulin

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7
Q

what are immunoglobulins produced by?

A

B cells (mostly plasma cells)

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8
Q

describe the structure of immunoglobulins?

A

Y shaped

two heavy chains and two light chains

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9
Q

the Fc portion is determined by what chain?

A

the heavy chain

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10
Q

what is the most common immunoglobulin ?

A

IgG

- 75% of total

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11
Q

what immunoglobulin is first to be produced and has the highest molecular weight?

A

IgM - pentamer

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12
Q

what immunoglobulin is used in parasitic infection and hypersensitivity

A

IgE

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13
Q

what are the two types of light chains?

A

kappa and lambda

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14
Q

what paraproteins are present in lymphoma?

A

IgM paraproteins

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15
Q

what paraproteins are present in myeloma?

A

IgG and IgA

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16
Q

does lymphoma or myeloma occur in the early stages of production?

A

lymphoma since IgM is made first before IgG and IgA

17
Q

myeloma is disease of what part of the body?

A

the bone marrow

18
Q

what age is most affected by myeloma?

A

70yrs

19
Q

what is the definition of myeloma?

A

disorder of plasma cells that result in excess production of a single type of immunoglobulin

20
Q

state some features of myeloma?

A

bone disease - lytic bone lesions, cord compression and hypercalcaemia

bone marrow failure (esp anaemia)

infections

21
Q

state some systemic effects of myeloma?

A

renal failure - due to immunoglobulin deposition

hyperviscosity - causes bleeding, cardiac failure, pulmonary congestion and renal failure

hypogammaglobulinaemia

amyloidosis

22
Q

what is amyloidosis ?

A

deposition of fibrillar protein

23
Q

when amyloidosis is caused by paraprotein or light chains what is it called

A

AL amyloid

24
Q

state some features of AL amyloid?

A 
nephrotic syndrome 
cardiac failure 
carpal tunnel syndrome 
autonomic neuropathy 
cutaneous infiltration
25
Q

are paraproteins common?

A

yes

26
Q

what is the condition called when an individual has a paraprotein <10% of plasma cells but has no symptoms?

A

monoclonal gammopathy of uncertain significance (MGUS)

27
Q

How is the myeloma diagnosis made?

A

> 10% of plasma cells in total bone marrow cell population

28
Q

what two things is the stage of myeloma based on?

A

albumin and beta-2 micro globulin

29
Q

what is the treatment of myeloma?

A 
chemotherapy 
bisphosphonate therapy 
RT 
steroids 
surgery - pinning of long bones and cord compression 
autologous stem transplant
30
Q

what is the medication used for bisphosphonate therapy called?

A

zoledronic acid

- blocks oestoclasts in cortical bone

31
Q

does IgM myeloma exist ?

A

no

32
Q

what is IgM paraproteins associated with ?

A

low grade lymphomas

33
Q

what is the clinical presentation of lymphoma?

A

bone marrow failure
lymphadenopathy
hepatosplenomegaly
B symptoms

34
Q

how would a suspected IgA myeloma be confirmed ?

A

eletrophoresis and immunfixation

35
Q

what test is done for microcytic anaemia?

A

ferritin

36
Q

what does a low ferritin suggest?

A

blood loss and iron deficiency

37
Q

what investigations should be done for a low ferritin ?

A

colonoscopy and CT scan

38
Q

case
- 88yo F, with fatigue, visuable disturbance and nosebleeds
low Hb, normal WCC/platelets
IgM paraprotein is identified on electrophoresis
what is the most likely diagnosis ?

A

low grade lymphoma

Y3 Haematology (14 decks)

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