Myeloma Flashcards
what is myeloma
malignancy of plasma cells causing monoclonal antibody expansion
function of B cells
produce antibodies
dendritic
what antibodies are monomers
IgD
IgE
IgG
what type of antibody is IgA
dimer
what type of antibody is IgM
pentamer
where do B cells travel to from bone marrow and why
follicle germinal centre of lymph nodes
identify antigens
then return to marrow as plasma or memory cells
what do plasma cells look like
clock face nucleus
open chromatin
blue cytoplasm
pale perinuclear area
what are monoclonal antibodies called
paraproteins
what are paraproteins seen in
MGUS myeloma amyloidosis lymphoma extramedullary plasmacytoma CLL
symptoms from tumour effect in myeloma
lytic bone lesions (punched out on XR)
hypercalcaemia
bone pain
marrow failure
effect of myeloma on bone physiology
increased osteoclast activity
decreased osteoblast activity
symptoms caused byt paraproteins
renal failure (cast cells)
immune suppression
increased plasma viscosity
amyloid
what are the most common paraproteins in myeloma
IgG
IgA
free light chains
investigations for myeloma
raised ESR, urea and Ca serum electrophoresis (separates proteins) serum immunofixation (classifies protein)
treatment for myeloma
steroids
alkylating agents
how is response to treatment measured in myeloma
paraprotein level
symptom control in myeloma
radio therapy for bone lesions
bisphosphonates
vertebroplasty if vertebral disease
what is a precursor to myeloma
monoclonal gammopathy of uncertain significance (MGUS)
criteria for MGUS
<30g/L paraproteins
bone marrow plasma cells <10%
no organ damage
what is amyloidosis
abnormal protein precipitates in tissues forming insoluble beta sheets
cause of amyloidosis
light chain on antibodies mutation
presentation of amyloidosis
multi-organ failure
indicatory of poor prognosis in amyloidosis
cardiac disease
investigations for amyloidosis
Biopsy:
stains with congo red
apple-green bifringence under polarised light
what is waldenstroms macroglobinaemia
lymphoplasmacytoid neoplasm (malignancy of cells between lymphocyte and plasma cell)
what paraprotein is produced in waldenstroms
IgM
presentation of waldenstroms
hyperviscosity B symptoms (weight loss, fever, night sweats)
treatment for waldenstroms
chemotherapy
plasmapherisis
