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haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

what are the different heavy chains associated with each Ab ?

A 
IgG - gamma
IgA - alpha
IgM - Mu
IgD - delta
IgE - epsilon
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2
Q

what is the most important test for possible myeloma ?

A

serum electrophoresis

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3
Q

what is the function of each Ab ?

A

IgM - initial phase of Ab production
IgG - most prevalent
IgA - mucous membrane
IgE - parasite immune response

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4
Q

what are the different parts of an antibody ?

A

Fab region - variable, defines target binding

Fc region - constant, defines subclass

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5
Q

what is a paraprotein ?

A

a monoclonal immunoglobulin present in blood or urine

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6
Q

what does presence of a paraprotein tell you ?

A

there is a monoclonal proliferation of a B cell/plasma cell in the body

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7
Q

what does serum electrophoresis look at ?

A

assesses antibody diversity, identifies paraprotein

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8
Q

what does an immunofixation look at ?

A

identifies class of paraprotein present IgG, IgM

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9
Q

what do IgM paraproteins indicate ?

A

lymphoma - mature B cell

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10
Q

what do IgG, IgA paraproteins indicate ?

A

myeloma - plasma cells

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11
Q

what is myeloma ?

A

neoplastic disorder of plasma cells, results in excessive production of single Ig type (paraprotein)
7th decade, black

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12
Q

what are features of myelomas ?

A

bone disease - lytic, fractures, cord compression, hypercalcaemia
marrow failure - anaemia
infections
CRAB

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13
Q

what is CRAB in myeloma ?

A

hyperCalcaemia
Renal failure
Anaemia
Bone disease

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14
Q

what are effects of the paraprotein ?

A

renal failure - cast nephropathy, Ig deposition of renal tubules
hyper viscosity - impaired microcirculation and hypo perfusion, mucosal bleeding, CV failure, confusion
hypogammaglobulinaemia - impaired production of Ig, infection

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15
Q

what is amyloidosis ?

A

group of diseases characterised by deposition of fibrillar protein
when caused by paraprotein or light chains - AL amyloid

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16
Q

what is the effect of amyloidosis ?

A 
nephrotic syndrome
LVH
carpal tunnel syndrome
autonomic neuropathy
cutaneous infiltration
17
Q

how common are paraproteins and is it always bad ?

A

3-4% over 75s
most have no problems
termed monoclonal gammopathy of uncertain significance MGUS

18
Q

how is myeloma diagnosed ?

A

paraprotein, type IgG, IgA, light chain

excess plasma cells in bone marrow >10% of total bone marrow cell pop

19
Q

how is myeloma treated ?

A 
chemotherapy - carfilzomib (protease inhibitors), lenalidomide (IMiDs)
bisphosphonate therapy - zoledronic acid
radiotherapy
steroids
surgery - pin bones
autologous stem cell transplant
20
Q

are IgM myelomas real ?

A

are they fuck

21
Q

what are features of lymphoma ?

A 
marrow failure
lymphadenopathy
hepatosplenomegaly
B symptoms
bone disease rare

haematology (18 decks)

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