Myeloma

Question 1

what is responsible for the production of antibodies?

Answer 1

B cells - mainly plasma cells

Question 2

which immunoglobulins role is mainly in mucous membrane immunity?

Answer 2

IgA

Question 3

what immunoglobulin is involved in parasite responses?

Answer 3

IgE

Question 4

what is the most abundant immunoglobulin type?

Answer 4

IgG

Question 5

What immunoglobulin is produced int he intitial phase of antibody production?

Answer 5

IgM

Question 6

which region on the antibody is the fixed and variable?

Answer 6

Fab = variable 
fc = fixed

Question 7

what part of the antibody is binding of antigens?

Answer 7

Fab region

Question 8

what is a paraprotein and what does its presence tell us?

Answer 8

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

Question 9

what is serum protein electrophoresis?

Answer 9

separates proteins based on size and charge

assesses antibody diversity and identifies paraproteins

Question 10

how can we test for the presence of paraproteins?

Answer 10

serum protein electrophoresis

Question 11

after electrophoresis, how can we identify what class of paraprotein is present?

Answer 11

immunofixation

Question 12

the presence of IgM paraproteins is suggestive of what type of cancer?

Answer 12

low grade lymphoma

Question 13

the presence of IgG or IgA paraproteins suggests what type of cancer?

Answer 13

myeloma

Question 14

the presence of what paraproteins are suggestive of;

• lymphoma?
• myeloma?

Answer 14

low grade lymphoma = IgM

myeloma = IgA / IgG

Question 15

at what age is myeloma most common?

Answer 15

70s

Question 16

in what ethnicity is myeloma most common?

Answer 16

black ethnicity

Question 17

what are the clinical features of myeloma?

Answer 17

bone disease;

• lytic bone lesions
• pathological fractures
• cord compression
• hypercalcaemia

bone marrow failure esp anaemia

infections

(CRAB)

Question 18

what clinical effects does the paraproteins cause in myeloma?

Answer 18

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

Question 19

how is myeloma diagnosed?

Answer 19

bone marrow biopsy - excess of plasma cells

> 10% of total bone marrow cell population

Question 20

what indicators are used to stage myeloma?

Answer 20

albumin

beta - 2 microglobulin

Question 21

what is the treatment for myeloma?

Answer 21

chemotherapy 
bisphosphonate therapy 
radiotherapy 
steroids
surgery - bones, cord compression
autologous stem cell transplant

Question 22

what is MGUS?

Answer 22

monoclonal gammopathy of uncertain significance

presence of paraproteins but nothing else wrong with them

require monitoring but majority not treated

more common than myeloma

Question 23

how can light chains of immunoglobulin be used to help in the diagnosis o myeloma?

Answer 23

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

Question 24

what condition is IgM paraproteins found in?

Answer 24

lymphoma

Question 25

what condition is IgG paraprotein found in?

Answer 25

Myeloma

Question 26

what condition is IgA paraprotein found in?

Answer 26

myeloma

Question 27

is myeloma a high grade or low grade?

Answer 27

low grade