Myeloma Flashcards
What cells proliferate in the bone marrow?
How does it cause bone destruction? - 2
What do these plasma cells produce in large amounts?
Plasma cells
Infiltration
Increases osteoclast activity
Immunoglobulins (e.g. IgG) so this is how it is classified
S+S:
Osteolytic bone lesions:
- Why do these bone lesions happen?
- What symptoms will patients complain of?
- What electrolyte will be raised?
Marrow infiltration:
- What diseases develop? - 3
Why may recurrent bacterial infections happen?
Why does myeloma cause kidney failure?
Lytic lesions are spots of bone damage that result from cancerous plasma cells building up in your bone marrow. Your bones can’t break down and regrow (your doctor may call this remodel) as they should.
Bone pain (especially back)
Calcium - hypercalcaemia ========= Pancytopenia: - Anaemia (fatigue) - Thrombocytopenia (bruising/bleeding) - Neutropenia (infection)
Due to immunoparesis and also because of neutropenia
As the M-proteins produced by the plasma cells destroy the nephrons as they block it
Investigations:
Bloods:
- FBC - what type of anaemia do they get?
- What can be used as a sign of cancer?
- Why are U&Es done?
- What may be found on bone profile?
Imaging:
- What imaging is done for the whole body?
A CRAB mneumonic can be used to summarise key findings in the history and investigations. What does it stand for?
Normocytic anaemia
ESR which is raised
In oncology, a high ESR has been found to correlate with overall poor prognosis for various types of cancer, including Hodgkin’s disease, gastric carcinoma, renal cell carcinoma, chronic lymphocytic leukaemia, breast cancer, colorectal cancer and prostate cancer.
Renal disease - urea and creatinine usually raised
Raised calcium
Normal alk phosphate
MRI
hyperCalcaemia
Renal impairment
Anaemia
Bone pain
Screening:
What is used to screen for myeloma in those >50 yrs old with new-onset back pain?
Serum and urine electrophoresis can be done for those >50 with new-onset back pain!
Management:
What is done for bone disease?
What is done for anaemia?
What is done for kidney failure? - 3
What is done for recurrent antibiotics?
Specific cancer Rx is the same!!
Biphosphonates
Analgesia
Transfusions and/or EPO
Fluids - need to maintain hydration
RRT
Stop nephrotoxic drugs
ABs
Prophylactic ABs, antivirals, vaccines, immunoglobulins
Complications - 3
Hyperviscosity syndrome
Spinal cord compression
Fractures
Hyperviscosity syndrome:
What 3 components in the blood cause an increase in plasma viscosity at high levels?
LOOK AT ANSWER!!!
Knowing the above, what may cause this?
There is a triad of symptoms:
- What neurological symptoms do they have?
- What visual symptoms do they have?
- Where may they get bleeding?
Plasmapheresis is used to Rx it. What is it?
Immunoglobulins
RBCs
WBCs
Myeloma
Polycythaemia vera
Leukaemia
Impaired cognition
Headache
Seizures
Visual changes from retinopathy
Mucosal bleeding
Plasmapheresis is a process in which the liquid part of the blood, or plasma, is separated from the blood cells. Typically, the plasma is replaced with another solution such as saline or albumin, or the plasma is treated and then returned to your body.
Hypercalcaemia:
What are some symptoms of hypercalcaemia?
What 3 Rx are given?
Confusion N&V Abdominal pain Headaches Depression
IV fluids
Steroids
Bisphosphonates
Myeloma can have relapsing and remitting phases just like MS - but over time it will eventually become permanent disease.
Myeloma can have relapsing and remitting phases just like MS - but over time it will eventually become permanent disease.
The useful mnemonic ‘CRAB’ is helpful in considering end-organ damage associated with myeloma. CRAB stands for: Calcium (high), Renal failure, Anaemia and Bone disease.
The useful mnemonic ‘CRAB’ is helpful in considering end-organ damage associated with myeloma. CRAB stands for: Calcium (high), Renal failure, Anaemia and Bone disease.
