Myeloma Flashcards
What is immunoglobulin?
Antibodies
What produces antibodies?
B cells - plasma cells
What are the 5 types of heavy chains and what immunoglobulin is produced?
Gamma - IgG Alpha - IgA Mu - IgM Delta - IgD Epsilon - IgE
What is the function of IgM?
Initial phase of antibody production - exists as a pentamer with highest molecular weight
What is the function of IgA?
Mucous membrane immunity
What is the function of IgE?
Parasite immune responses
Hypersensitivity
What is paraprotein?
Monoclonal immunoglobulin present in blood or urine
What does presence of paraprotein tell us?
Monoclonal proliferation of a B lymphocyte/plasma cell somewhere in the body
What is serum protein electropheresis?
Seperates protein based on size and charge - forms characteristic pattern of bands of different widths and intensities based on proteins present
What test is used to identify paraprotein?
Electropheresis - assess diversity of antibodies
What does total immunoglobulin levels do?
Measures Ig subclasses by heavy chain/Fc section
What is immunofixation used for?
Identifying class of paraprotein present
What does light chain assessment do?
Assesses imbalance/excess of light chains in urine/serum
What paraprotein subtypes are associated with lymphoma?
IgM paraproteins
What paraprotein subtypes are associate with myeloma?
IgG
IgA
What is myeloma?
Neoplastic disorder of plasma cells, resulting in excessive production of a single type of immunoglobulin
What is lymhpoma associated with high IgM?
B lymphocytes produce IgM at start of immune response - higher numbers of b lymphocytes lead to more IgM
What is the CRAB mnemonic for features of myeloma?
hyperCalcaemia
Renal failure
Anaemia
Bone disease
What are systemic effects of paraprotein?
Renal failure - cast nephropathy
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis
What are features of hyperviscosity?
Bleeding - retinal, oral, nasal, cutaneous Cardiac failure Pulmonary congestion Confusion Renal failure
What is hypogammaglobulinaemia?
Impaired production of normal immunoglobulin leading to increased infections
What is amyloidosis?
Group of diseases characterised by deposition of fibrillar protein
What are features of amyloidosis?
Nephrotic syndrome Cardiac failure Carpal tunnel syndrome Autonomic neuropathy Cutaneous infiltration
How is amyloidosis diagnosed?
Biopsy of site with amyloidosis
How is myeloma diagnosed?
Excess plasma cells in bone marrow - >10% of total bone marrow cell population
What is monoclonal gammopathy of uncertain significance? (MGUS)
Paraproteins without any other clinical features
What is the most common paraprotein in myeloma?
IgG
How is myeloma staged?
Based on albumin and beta-2 microglobulin
How is myeloma treated?
Chemotherapy - proteasome inhibitors, Immuno-Modulatory imide Drugs, monoclonal antibodies
Bisphosphonate therapy
Radiotherapy
Steroids
Surgery - pinning of long bones, decompession of spinal cord
Autologous stem cell transplant
