Myeloma Flashcards
Where are antibodies produced?
B cells (mostly Plasma cells)
What are the 5 types of heavy chains?
Gamma Alpha Mu Delta Epsilon
What do IgM do?
Pentamer structure
Initial phase of antibody production
Which antibody is most prevalent?
IgG
What is the role of IgA?
Mucous membrane immunity
What is the role of IgE?
Parasite immune response
Hypersensitivity
What types of light chains are there?
Kappa and Lambda
Random selection for each cell
What are the 2 regions of an antibody?
Fab region - variable, defines target binding
Fc region - constant, defines subclass
What is a paraprotein?
Monoclonal antibody present in blood or urine
Abnormal antibody fragment
Presence of paraproteins tells us what?
Monoclonal proliferation of a B lymphocyte/plasma cell in the body
What tests are used to test antibodies?
Total Immunoglobulin levels
Electrophoresis
Immunofixation - class of paraproteins
Light chains
How are paraproteins tested for?
Serum protein electrophoresis
IgM paraproteins are suggestive of what?
Lymphoma
IgG and IgA paraproteins are suggestive of what?
Myeloma
At what point are IgG, IgA made?
Mature plasma cells after isotype switching
At what point are IgM made?
Maturing B-lymphocytes at start of immune response
What is Myeloma?
Neoplastic disorder of plasma cells, leading to an excess production of a single immunoglobulin
Myeloma is more common in which groups?
70s
Black > white
What are the features of myeloma?
Bone disease - Lytic lesions - Pathological fractures - Cord compression - Hypercalcaemia (bone damage) Bone marrow failure (anaemia) Infections Renal failure CRAB
What are the CRAB features of myeloma?
hyperCalcaemia (bone damage)
Renal failure
Anaemia
Bone disease
What are the effects of paraprotein on the body?
Renal failure - cast nephropathy
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis
How is Myeloma diagnosed?
Paraproteins (and typing (IgG++))
Excess plasma cells in bone marrow (>10% of total bone marrow cells)
Albumin and beta-2 for staging
How do paraproteins cause renal failure?
Immunoglobulin deposits build up and block the renal tubules
What is hypogammaglobulinaemia?
Impaired production of normal Igs
Leads to infection
What is hyperviscosity?
Impaired microcirculation and hypoperfusion due to paraproteins
Causes bleeding
Can cause congestion/heart issues
What amyloid is associated with paraprotein?
AL amyloid
How does amyloidosis present?
Nephrotic syndrome
LVH (cardiac failure)
Carpal tunnel syndrome
Autonomic neuropathy
How is myeloma treated?
Chemotherapy Bisphosphonate therapy Radiotherapy Steroids (immediate recovery) Surgery (long bone pinning, spinal decompression) Stem cell transplant
IgM paraproteins are associated with what?
Low-grade Lymphoma (NOT myeloma)
What light chains are assessed for?
Kappa and Lambda chains
