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Haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What produces antibodies?

A

B cells, mostly plasma cells

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2
Q

What is the primary role of antibodies?

A

To recognise and bind pathogens

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3
Q

What is the basic structure of antibodies?

A

Y-shaped

2 heavy chains, 2 light chains

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4
Q

Which part of the antigen is variable?

A

Antigen binding site

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5
Q

What defines the Fc portion of an antibody?

A

Heavy chains

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6
Q

What are the types of heavy chain?

A 
IgM
IgG
IgA
IgE
IgD
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7
Q

What is the most prevalent antibody subclass?

A

IgG

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8
Q

Which immunoglobulin is involved in mucous membrane immunity?

A

IgA

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9
Q

Which immunoglobulin is involved in parasite immune responses and hypersensitivity?

A

IgE

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10
Q

Which antibody exists as a pentamer?

A

IgM

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11
Q

What are the types of light chain?

A

Kappa or lambda

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12
Q

How is light chain chosen for each cell?

A

Random selection but each cell will only make one type of light chain with one specificity

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13
Q

What are the two regions of immunoglobulins?

A

Fab region - variable, defines target binding

Fc region - constant, defines subclass

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14
Q

What is a paraprotein?

A

Monoclonal immunoglobulin present in blood or urine

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15
Q

What does the presence of paraproteins indicate?

A

There is monoclonal proliferation of a B lymphocyte/plasma cell somewhere in the body

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16
Q

What is serum protein electropheresis?

A

Separates protein based on size and charge

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17
Q

What tests can be used to assess immunoglobulins?

A

Total immunoglobulin levels
Electrophoresis
Immunofixation
Light chains

18
Q

What is the function of total immunoglobulin level tests?

A

Measure Ig subclasses by heavy chain/Fc section

19
Q

What is the function of electrophoresis?

A

Identifies paraproteins

20
Q

What is the function of immunofixation?

A

Identifies what class of paraprotein is present

21
Q

What is the function of testing for light chains?

A

Assesses imbalance/excess of light chains in urine/serum

22
Q

What do IgM paraproteins indicate?

A

Lymphoma

Maturing B lymphocytes make IgM antibody at the start of the immune response

23
Q

What do IgG/IgA paraproteins indicate?

A

Myeloma

Mature plasma cells generate these types of immunoglobulin after isotype switching

24
Q

What is myeloma?

A

Neoplastic disorder of plasma cells, resulting (usually) in excessive production of a single type of immunoglobulin (paraprotein)

Clinical manifestations may result from direct effect of plasma cells, or effect of paraprotein

25
Q

At what age is myeloma most common?

A

7th decade

26
Q

Features of myeloma

A 
CRAB -
hyperCalcaemia
Renal failure
Anaemia
Bone disease
   -cord compression
   -pathological fractures
   -lytic bone lesions
27
Q

Effects of the paraprotein

A

Renal failure - cast nephropathy
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis

28
Q

How do paraproteins cause cast nephropathy?

A

Immunoglobulin deposition and blockage of renal tubules

29
Q

Clinical features of hyperviscosity

A 
Bleeding (retinal, oral, nasal, cutaneous)
Cardiac failure
Pulmonary congestion
Confusion
Renal failure
30
Q

What is hypogammaglobulinaemia?

A

Impaired production of normal Immunoglobulin

Tendency to infection

31
Q

What is amyloidosis?

A

Group of diseases characterised by deposition of fibrillar protein
Morphological appearances, physical structure are similar
Biochemical or protein composition can vary

32
Q

What is amyloidosis caused by paraproteins or light chains?

A

AL amyloid (primary amyloidosis)

33
Q

What are the complications of AL amyloid?

A 
Nephrotic syndrome
Cardiac failure (LVH)
Carpal tunnel syndrome
Autonomic neuropathy
Cutaneous infiltration
34
Q

How is myeloma diagnosed?

A

By finding excess plasma cells in the bone marrow (>10% of total bone marrow population)

35
Q

What is the most common paraprotein in myeloma?

A

IgG

Then IgA/light chain only

36
Q

How is myeloma staged?

A

Based on albumin and beta-2 microglobulin

37
Q

Myeloma treatment

A 
Chemotherapy
Bisphosphonate therapy
Radiotherapy
Steroids
Surgery
Autologous stem cell transplant
38
Q

Chemotherapy

A

Proteasome inhibitors
IMiDs
Monoclonal antibodies

39
Q

Bisphosphonate therapy

A

Zoledronic acid

40
Q

What surgery can be required in myeloma?

A

Pinning of long bones

Decompression of spinal cord

41
Q

What are IgM paraproteins associated with?

A

Low grade lymphomas

42
Q

IgM myeloma

A

Does not exist

Haematology (18 decks)

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