Myeloma

Question 1

Where are antibodies produced?

Answer 1

B cells (mostly Plasma cells)

Question 2

What are the 5 types of heavy chains?

Answer 2

Gamma
Alpha 
Mu 
Delta
Epsilon

Question 3

What do IgM do?

Answer 3

Pentamer structure

Initial phase of antibody production

Question 4

Which antibody is most prevalent?

Answer 4

IgG

Question 5

What is the role of IgA?

Answer 5

Mucous membrane immunity

Question 6

What is the role of IgE?

Answer 6

Parasite immune response

Hypersensitivity

Question 7

What types of light chains are there?

Answer 7

Kappa and Lambda

Random selection for each cell

Question 8

What are the 2 regions of an antibody?

Answer 8

Fab region - variable, defines target binding

Fc region - constant, defines subclass

Question 9

What is a paraprotein?

Answer 9

Monoclonal antibody present in blood or urine

Abnormal antibody fragment

Question 10

Presence of paraproteins tells us what?

Answer 10

Monoclonal proliferation of a B lymphocyte/plasma cell in the body

Question 11

What tests are used to test antibodies?

Answer 11

Total Immunoglobulin levels
Electrophoresis
Immunofixation - class of paraproteins
Light chains

Question 12

How are paraproteins tested for?

Answer 12

Serum protein electrophoresis

Question 13

IgM paraproteins are suggestive of what?

Answer 13

Lymphoma

Question 14

IgG and IgA paraproteins are suggestive of what?

Answer 14

Myeloma

Question 15

At what point are IgG, IgA made?

Answer 15

Mature plasma cells after isotype switching

Question 16

At what point are IgM made?

Answer 16

Maturing B-lymphocytes at start of immune response

Question 17

What is Myeloma?

Answer 17

Neoplastic disorder of plasma cells, leading to an excess production of a single immunoglobulin

Question 18

Myeloma is more common in which groups?

Answer 18

70s

Black > white

Question 19

What are the features of myeloma?

Answer 19

Bone disease
 - Lytic lesions
 - Pathological fractures
 - Cord compression
 - Hypercalcaemia (bone damage)
Bone marrow failure (anaemia)
Infections 
Renal failure
CRAB

Question 20

What are the CRAB features of myeloma?

Answer 20

hyperCalcaemia (bone damage)
Renal failure
Anaemia
Bone disease

Question 21

What are the effects of paraprotein on the body?

Answer 21

Renal failure - cast nephropathy
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis

Question 22

How is Myeloma diagnosed?

Answer 22

Paraproteins (and typing (IgG++))
Excess plasma cells in bone marrow (>10% of total bone marrow cells)
Albumin and beta-2 for staging

Question 23

How do paraproteins cause renal failure?

Answer 23

Immunoglobulin deposits build up and block the renal tubules

Question 24

What is hypogammaglobulinaemia?

Answer 24

Impaired production of normal Igs

Leads to infection

Question 25

What is hyperviscosity?

Answer 25

Impaired microcirculation and hypoperfusion due to paraproteins
Causes bleeding
Can cause congestion/heart issues

Question 26

What amyloid is associated with paraprotein?

Answer 26

AL amyloid

Question 27

How does amyloidosis present?

Answer 27

Nephrotic syndrome
LVH (cardiac failure)
Carpal tunnel syndrome
Autonomic neuropathy

Question 28

How is myeloma treated?

Answer 28

Chemotherapy 
Bisphosphonate therapy 
Radiotherapy
Steroids (immediate recovery)
Surgery (long bone pinning, spinal decompression)
Stem cell transplant

Question 29

IgM paraproteins are associated with what?

Answer 29

Low-grade Lymphoma (NOT myeloma)

Question 30

What light chains are assessed for?

Answer 30

Kappa and Lambda chains