Myeloma Flashcards
what is responsible for the production of antibodies?
B cells - mainly plasma cells
which immunoglobulins role is mainly in mucous membrane immunity?
IgA
what immunoglobulin is involved in parasite responses?
IgE
what is the most abundant immunoglobulin type?
IgG
What immunoglobulin is produced int he intitial phase of antibody production?
IgM
which region on the antibody is the fixed and variable?
Fab = variable fc = fixed
what part of the antibody is binding of antigens?
Fab region
what is a paraprotein and what does its presence tell us?
monoclonal proliferation immunoglobulin present in blood or urine
if present it tells us that there is monoclonal proliferation of a B lymphocyte / plasma cells somewhere else in the body
what is serum protein electrophoresis?
separates proteins based on size and charge
assesses antibody diversity and identifies paraproteins
how can we test for the presence of paraproteins?
serum protein electrophoresis
after electrophoresis, how can we identify what class of paraprotein is present?
immunofixation
the presence of IgM paraproteins is suggestive of what type of cancer?
low grade lymphoma
the presence of IgG or IgA paraproteins suggests what type of cancer?
myeloma
the presence of what paraproteins are suggestive of;
- lymphoma?
- myeloma?
low grade lymphoma = IgM
myeloma = IgA / IgG
at what age is myeloma most common?
70s
in what ethnicity is myeloma most common?
black ethnicity
what are the clinical features of myeloma?
bone disease;
- lytic bone lesions
- pathological fractures
- cord compression
- hypercalcaemia
bone marrow failure esp anaemia
infections
(CRAB)
what clinical effects does the paraproteins cause in myeloma?
renal failure - cast nephropathy
hyper viscosity
- bleeding; retinal, oral, nasal, cutaneous
- cardiac failure, pul. congestion, confusion, renal failure
hypogammaglobulinaemia
- tendency to infection
amyloidosis
- nephrotic syndrome
- cardiac failure
- carpal tunnel syndrome
- autonomic neuropathy
- cutaneous infiltration
how is myeloma diagnosed?
bone marrow biopsy - excess of plasma cells
> 10% of total bone marrow cell population
what indicators are used to stage myeloma?
albumin
beta - 2 microglobulin
what is the treatment for myeloma?
chemotherapy bisphosphonate therapy radiotherapy steroids surgery - bones, cord compression autologous stem cell transplant
what is MGUS?
monoclonal gammopathy of uncertain significance
presence of paraproteins but nothing else wrong with them
require monitoring but majority not treated
more common than myeloma
how can light chains of immunoglobulin be used to help in the diagnosis o myeloma?
assess the balance of light chain sin the blood or urine
if there is an imbalance of labda and kappa then there is a monoclonal imbalance abnormal as there should be equal amounts
what condition is IgM paraproteins found in?
lymphoma
what condition is IgG paraprotein found in?
Myeloma
what condition is IgA paraprotein found in?
myeloma
is myeloma a high grade or low grade?
low grade
