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Systems- Haematology > Myeloma > Flashcards

Myeloma Flashcards

(66 cards)

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1
Q

What is myeloma?

A

Cancer of plasma cells

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2
Q

What are the 2 types of myeloma?

A

Paraprotein myeloma

Light chain myeloma

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3
Q

What are the 2 most common paraproteins that occur in myeloma?

A

IgG

IgA

(All we hear is radio GA GA)

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4
Q

What type of immunoglobulin paraprotein is rare but associated with severe myeloma?

A

IgD

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5
Q

What is a paraprotein?

A

Monoclonal immunoglobulins

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6
Q

What are the 4 main features of myeloma?

A

CRAB

HyperCalcemia
Renal failure
Anaemia
Bone disease

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7
Q

What are some of the morphological features of myeloma?

A

Off-centred nuclei

Many active plasma cells

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8
Q

What is the most common presentation of myeloma?

A

Worsening back pain that doesn’t respond to treatment and tiredness

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9
Q

For any patient that presents with back pain, what exam should you do and why?

A

Neuro exam

Need to exclude any serious spinal disease like CES

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10
Q

When looking at protein and albumin levels, what would be diagnostic of myeloma and why?

A

High total protein levels but low albumin

The high protein level is due to an influx of paraproteins

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11
Q

Why are patients with myeloma at an increased risk of infection?

A

As they also have bone marrow failure, so they have neutropenia and can’t fight infections

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12
Q

As patients with myeloma are at an increased risk of infection, what antibiotic would you give as prophylaxis for PJP?

A

Co-trimoxazole

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13
Q

Why does hyperviscosity occur in myeloma?

A

As the increased number of immunoglobulins can clog up blood lol

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14
Q

How may hyperviscosity present?

A

Retinal haemorrhages

Headaches

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15
Q

Can you give myeloma patients a blood transfusion?

A

No, as the increased number of immunoglobulins results in hyperviscosity

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16
Q

What are the 2 types of light chain myeloma?

A

Kapa

Lambda

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17
Q

To determine the type of light chain myeloma, what do you look for?

A

Kappa:Lambda ratio

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18
Q

What is the most common type of light chain myeloma?

A

Kappa

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19
Q

Can paraproteins and light chains both occur at the same time in myeloma?

A

Of course

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20
Q

Chemotherapy is one of the treatments for myeloma, what is a potential complication and levels of what are greatly increased?

A

Tumour lysis syndrome

Increased levels of:
Urate
Phosphate
Potassium

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21
Q

For a blood test in myeloma, what would happen to the following:

A. Hb
B. Total protein levels 
C. Albumin 
D. Creatinine 
E. Calcium 
F. Urea
A 
A. Decreased
B. Increased 
C. Decreased 
D. Increased 
E. Increased 
F. Increased
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22
Q

What are the main investigations to do for myeloma?

A 
Serum electrophoresis 
Immunofixation 
Serum light chain levels 
Urine tests 
Bloods 
X-ray 
Bone marrow aspirate
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23
Q

On looking at an X-ray for a myeloma patient, what is a typical sign?

A

Pepper pot skull

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24
Q

Why do you do a urine test for myeloma?

A

As renal failure occurs

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25
What urinary protein so you check for in myeloma?
Bence-Jones protein
26
What are the treatments for myeloma?
``` Chemotherapy and radiotherapy Targeted molecular therapy Biophosphonates Steroids Autologous stem cell transplant Surgical decompression Surgical pinning of long bones ```
27
How can you treat bone disease that occurs in myeloma?
Biophosphates Surgical decompression Surgical pinning of long bones
28
What type of biophosphonate is commonly used when treating bone disease in myeloma?
Zaledronic acid
29
What type of stem cell transplantation is used for myeloma and where do the stem cells comes from?
Autologous stem cell transplantation Stem cells come from the patient (Opposite of allogenic)
30
What type of bone lesions occur in myeloma?
Lytic bone lesions
31
What can you see on a blood film for myeloma?
Rouleaux formation Circulating plasma cells
32
On a bone marrow aspirate for myeloma, what % of clinical plasma cells need to be present in bone marrow?
>10 | Greater than 10 percent
33
What bone diseases occur in myeloma?
Lyric lesions Cord compression Compound fractures
34
Apart from hyperviscosity, what else does an increase in immunoglobulins result in?
Amyloidosis | Hypogammaglobinemia
35
What investigation determines the type of immunoglobulin present in myeloma?
Serum electrophoresis
36
What are some of the risk factors for myeloma?
The elderly
37
What is myeloma associated with?
MGUS Osteoporosis Amyloidosis
38
What does MGUS stand for?
Monoclonal Gammopathy of Uncertain Significance
39
If you have an increased number of paraproteins, but have no symptoms and are clinically sound, what is the most likely diagnosis?
MGUS
40
Immunoglobulins are usually diverse and are sporadic in their arrangement. What do you call a colony of one type of immunoglobulin?
Paraproteins
41
Why does fatigue occur in myeloma?
As there is an increase in calcium levels, which results in decreased membrane excitability
42
What are the differentials for myeloma?
MGUS Non-Hodgkins lymphoma Amyloidosis Leukaemia
43
Cigarettes increase the risk of getting pretty inch every cancer, what is an early sign of cancer in relation to cigarettes?
Gradual loss of liking the taste
44
How can MGUS develop into myeloma?
As the paraprotein count increases by 1% each year, so will gradually increase you risk of developing myeloma
45
What type of fractures occur in myeloma?
Pathological fracture
46
How does myeloma cause spinal cord compression?
``` Vertebral collapse (due to fractures) Plasma-cytoma ```
47
How is spinal cord compression treated?
``` High-dose steroids (to reduce swelling) Radiotherapy (if soft tissue mass) Surgical decompression (if non-soft tissue mass) ```
48
Before an autologous stem cell transplant, what is given to patients waiting to get one and why?
G-CSF To stimulate stem cell production
49
Mucositis is a complication of chemotherapy, what symptoms can it cause?
Mouth pain GI upset Diarrhoea
50
If a patient has mucositis, can they receive a stem cell transplant?
No It's a contraindication
51
``` What syndrome, that is related to myeloma due to it also involving increased paraproteins, is characterised by: Polyneuropathy Organmegaly Endocrinopathy Monoclonal antibodies (paraproteins) Skin changes ```
POEMS syndrome
52
What is the closest treatment of being curative for myeloma?
Autologous stem cell transplant
53
Is myeloma curable?
Nah mate
54
How long can stem cells from an autologous stem cell transplant be frozen?
10 years
55
When you give high-dose steroids, what type of medication do you ALWAYS have to give to prevent GI upset?
PPI
56
What are urinary Bence-Jones proteins?
Light chains in urine
57
What is a good investigation to look at lytic bone lesions in myeloma?
CT skeletal survey
58
Why can a CT skeletal survey be used in myeloma?
As contrast is not involved, so it can be used in cases of renal failure (like in myeloma)
59
For PJP prophylaxis, when will Pentamidine be used ahead of cotrimoxazole and why?
In situations of BM failure (e.g. post chemo or SCT) Because cotrimoxazole can cause agranulocytosis
60
What are the morphological signs of myeloma on a BM?
>10% clonal plasma cells Immature plasma cells "Clock-face" nuclei Eccentric nuclei
61
What are the morphological signs of myeloma on a blood film?
Rouleaux formation | Circulating plasma cells
62
Give 3 examples of chromosome mutations that can cause myeloma?
t(11,14) 11q deletion 13q14 deletion
63
What is the main stay management of myeloma?
Batter them with chemo, then give an autologous stem cell transplant
64
What is the triad of clinical features for myeloma?
>10% clonal plasma cells Lytic bone lesions Free light chains in urine
65
What injections are given to myeloma patients who have BM failure and are in need of more RBCs?
EPO injections
66
What Ig tends to be decreased in hypogammaglobinemia?
IgG

Systems- Haematology (26 decks)

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