Myeloma Flashcards
What does immunoglobulin total levels measure and what should the measurements be?
Immunoglobulin total levels measures the amount of each class of antibodies (IgG etc)
IgG : 6-15g/l
IgA : 1-4.5g/l
IgM : 0.5-2.0g/
What is a paraprotein?
Too many of one type of antibody
A paraprotein – monoclonal immunoglobulin present in blood or urine
If present, it tells us that there is monoclonal proliferation of a B lymphocyte / plasma cell somewhere in the body
What is multiple myeloma?
Multiple myeloma is a plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of the bone marrow by plasma cells, and the presence of a monoclonal immunoglobulin (or immunoglobulin fragment) in the serum or urine. It is usually associated with osteolytic bone disease, anaemia, and renal failure anaemia, and renal failure
Myeloma is diagnosed by finding excess plasma cells in the bone marrow, must comprise > 10% of total bone marrow cell population
What is the presentation of multiple myeloma?
Anaemia Bone pain (back pain) -lytic bone lesions -pathological fractures -cord compression Monoclonal gammopathy of undetermined significance (MGUS) Infections Fatigue Renal impairment Can get thrombocytopenia
CRAB – hypercalcaemia, renal failure, anaemia, bone disease
What investigations should be done in myeloma?
Serum/urine electrophoresis- paraprotein spike and hypogammaglobulinaemia Skeletal survey Whole-body CT Serum free light-chain assay Bone marrow aspirate and biopsy- plasma cells >10% bone marrow population Serum calcium-hypercalcaemia FBC-anaemia Creatinine, urea Serum beta2-microglobulin Serum albumin Whole-body MRI CRP LDH Cytogenetics and fluorescence in situ hybridisation analysis
What class of paraproteins cause what disease?
IgM paraproteins = lymphoma
IgG, IgA paraproteins = myeloma
What effect does a paraprotein have on the body?
Renal failure – cast nephropathy
Immunoglobulin deposition and blockage of renal tubules
Hyperviscosity
Syndrome caused by increased viscosity in blood, impaired microcirculation and hypoperfusion
Commonest clinical feature is bleeding – retinal, oral, nasal, cutaneous
Can also cause cardiac failure, pulmonary congestion, confusion, renal failure
Hypogammaglobulinaemia
Impaired production of normal Immunoglobulin
Tendency to infection
What is amyloidosis?
Group of diseases characterised by deposition of fibrillar protein
Morphological appearances, physical structure are similar
Biochemical or protein composition can vary
When caused by a paraprotein or light chains – AL amyloid
Nephrotic syndrome Cardiac failure (LVH) Carpal tunnel syndrome Autonomic neuropathy Cutaneous infiltration
What is MGUS?
Monoclonal gammopathy of uncertain significance
Paraprotein present causing no problems
What is the management of myeloma?
Chemotherapy Proteasome inhibitors (carfilzomib, bortezomib), IMiDs (lenalidomide, pomalidomide), monoclonal antibodies Bisphosphonate therapy Zoledronic acid Radiotherapy Steroids Surgery Pinning of long bones; decompression of spinal cord Autologous stem cell transplant
