Myeloma Flashcards
what are the different heavy chains associated with each Ab ?
IgG - gamma IgA - alpha IgM - Mu IgD - delta IgE - epsilon
what is the most important test for possible myeloma ?
serum electrophoresis
what is the function of each Ab ?
IgM - initial phase of Ab production
IgG - most prevalent
IgA - mucous membrane
IgE - parasite immune response
what are the different parts of an antibody ?
Fab region - variable, defines target binding
Fc region - constant, defines subclass
what is a paraprotein ?
a monoclonal immunoglobulin present in blood or urine
what does presence of a paraprotein tell you ?
there is a monoclonal proliferation of a B cell/plasma cell in the body
what does serum electrophoresis look at ?
assesses antibody diversity, identifies paraprotein
what does an immunofixation look at ?
identifies class of paraprotein present IgG, IgM
what do IgM paraproteins indicate ?
lymphoma - mature B cell
what do IgG, IgA paraproteins indicate ?
myeloma - plasma cells
what is myeloma ?
neoplastic disorder of plasma cells, results in excessive production of single Ig type (paraprotein)
7th decade, black
what are features of myelomas ?
bone disease - lytic, fractures, cord compression, hypercalcaemia
marrow failure - anaemia
infections
CRAB
what is CRAB in myeloma ?
hyperCalcaemia
Renal failure
Anaemia
Bone disease
what are effects of the paraprotein ?
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
what is amyloidosis ?
group of diseases characterised by deposition of fibrillar protein
when caused by paraprotein or light chains - AL amyloid
what is the effect of amyloidosis ?
nephrotic syndrome LVH carpal tunnel syndrome autonomic neuropathy cutaneous infiltration
how common are paraproteins and is it always bad ?
3-4% over 75s
most have no problems
termed monoclonal gammopathy of uncertain significance MGUS
how is myeloma diagnosed ?
paraprotein, type IgG, IgA, light chain
excess plasma cells in bone marrow >10% of total bone marrow cell pop
how is myeloma treated ?
chemotherapy - carfilzomib (protease inhibitors), lenalidomide (IMiDs) bisphosphonate therapy - zoledronic acid radiotherapy steroids surgery - pin bones autologous stem cell transplant
are IgM myelomas real ?
are they fuck
what are features of lymphoma ?
marrow failure lymphadenopathy hepatosplenomegaly B symptoms bone disease rare
