Myeloma Flashcards
Explain the pathophysiology
Clonal proliferation of BM plasma cells
Abnormal monoclonal Igs (M proteins) proliferate in the blood = paraproteinaemia
What are the RFs
M>F
Increased age
+ve FHx
What is the median age for getting it?
70
Give the mnemonic for signs and sx
C - calcium (elevated)
R - renal failure
A - anaemia
B - bone lesions
Which bones are usually affected? How can it present?
Spine + ribs
Worse w activity
Bone fractures -> persistent localised pain
Spinal cord compression or kyphosis
What type of anaemia is present?
normochromic normocytic.
What are the causes of renal failure in MM?
Deposition of light chains in tubules
Hypercalcaemia
Hyperuricaemia
Amyloid deposition
How does BM infiltration present
anaemia
thrombocytopenia
neutropenia
What common infections occur due to MM?
pyelonephritis
pneumonia
What neurological sx may be present? why do they occur?
Confusion, weakness and fatigue – hypercalcaemia
Headaches and visual disturbances – hyperviscosity (present in some paraproteinaemia)
Peripheral neuropathy – amyloid deposition
Limb weakness and loss of bowel/bladder control – spinal cord compression
What ix would u do?
- FBC, serum Ca2+, ESR
- Protein electrophoresis in blood and urine
- Peripheral blood film
- Serum urea, creatinine, electrolytes, albumin, uric acid
- XR symptomatic areas to rule out pathological fractures
- Ig measurement
- BM biopsy
- Beta 2 microglobulin - elevated
What would you see on peripheral blood film?
rouleaux - red cells stacked on top of each other
why would u see a raised uric acid?
high cell turnover
what would u see on protein electrophoresis
Bence Jones protein
may demonstrate a paraprotein band
why would u measure calcium
bone profile
how is MM classified?
based on which Ig is produced:
- IgG 2/3
- IgA 1/3
When are free light chain levels measured?
When assessing response to rx
What are diagnostic features?
- paraproteinaemia or serum protein immunofixation or BJ proteins in urine
- CT/MRI - lytic bone lesions
- increase in BM plasma cells on BM aspirate or trephine biopsy
What is symptomatic rx?
- BISPHOSPHONATES - reduce bone pain and disease
- CORRECT ANAEMIA - darbepoietin (erythropoeitin), blood transfusion
- Chemo e.g. cyclophosphamide
- CS e.g. dexamethasone + prednisolone
- immunomodulatory drugs - thalidomide,
- High dose drug therapy + stem cell transplant
- DVT proph e.g. aspirin, LMWH, warfarin
Whatdrugs should be avoided ?
aminoglycosides for inf
NSAIDs - renal toxicity
What is the prognosis
usually incurable
what indicates a worse prognosis?
increased levels of beta 2 micro globulin high plasma cell counts diffuse multiple bone lesions hypercalcaemia v high levels of M protein in blood renal impairment
what are complications of MM
- spinal cord compression - back pain leg weakness paraesthesia, urinary retention/incontinence
- hyper viscosity - reduced cognition, loss of vision, bleeding
What is the rx of hyperviscosity?
plasmapheresis to remove light chains
What is seen on CXR in myeloma?
pepper pot skull
what is the asymptomatic premalignant stage called?
monoclonal gammopathy of undetermined significance
