Myeloma Flashcards
pathology of myeloma
neoplasma of bone marrow plasma cells, producing excessive amounts of one antibody
presentation of myeloma
hyperCalcaemia Renal failure Anaemia Bone disease bleeding infection backache bone marrow failure
peak age of myeloma
> 70
what does a total immunoglobulin assay look at
measures Ig subclasses by their heavy chain
which Ig is a pentamer
IgM
what test seperates proteins in serum by size and charge to give a graph of different width and intensity bands
serum protein electrophoresis
what does an ‘end spike’ on electrophoreisis indicate
high IgG
how does myeloma cause hypercalcaemia
myeloma causes raised IL-1 and TNF –> incresaed osteoclast activity –> bone breakdown –> raised calcium
true/false - paraproteins cause bleeding by depositing in small vessels
false - they cause bleeding by increasing blood viscosity
in myeoma there is an excess of light-chains causing amyoid light-chain amyloidosis. what is the clinical condition that arises from this
nephrotic syndrome
features of bone on x-ray
osteolytic lesions
rain-drop skull
osteoporosis
investigations in myeloma
bone marrow biopsy serum protein electrophoresis serum Ca2+ x-ray urine protein electrophoresis for Bence Jones' protein light-chain assay
mainstay of treatment in myeloma
chemo –> proteasome inhibitors (bortezomib)
other types of treatment in myeloma
chemo with monoclonal antibodies of IMiDs radiotherapy steroids surgery to pin long bones bisphosphonate therapy
what type of drug is bortezomib
proteasome inhibitor
which of the following is not a major criteria for diagnosis of myeloma
a) elevated M protein
b) 30% plasma cells in marrow
c) plasmacytoma
d) osteolytic lesions
d) osteolytic lesions - this is a minor criteria
why are people with myeloma prone to infection
abnormal antibody production outcrowds the good antibodies –> HYPOGAMMAGLOBULINAEMIA
what type of Ig are in excess in myelom
IgG or IgA
what is IgM myeloma
apparently doesn’t exist - is a side effect of low-grade lymphomas
what are B symptoms
fever, malaise, >10% weight loss in 3 months
where can light chains be detected
in urine and blood
