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Systems- Haematology > Myeloma > Flashcards

Myeloma Flashcards

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
Q

What urinary protein so you check for in myeloma?

A

Bence-Jones protein

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26
Q

What are the treatments for myeloma?

A 
Chemotherapy and radiotherapy
Targeted molecular therapy 
Biophosphonates 
Steroids 
Autologous stem cell transplant 
Surgical decompression 
Surgical pinning of long bones
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27
Q

How can you treat bone disease that occurs in myeloma?

A

Biophosphates
Surgical decompression
Surgical pinning of long bones

28
Q

What type of biophosphonate is commonly used when treating bone disease in myeloma?

A

Zaledronic acid

29
Q

What type of stem cell transplantation is used for myeloma and where do the stem cells comes from?

A

Autologous stem cell transplantation

Stem cells come from the patient

(Opposite of allogenic)

30
Q

What type of bone lesions occur in myeloma?

A

Lytic bone lesions

31
Q

What can you see on a blood film for myeloma?

A

Rouleaux formation

Circulating plasma cells

32
Q

On a bone marrow aspirate for myeloma, what % of clinical plasma cells need to be present in bone marrow?

A

> 10

Greater than 10 percent

33
Q

What bone diseases occur in myeloma?

A

Lyric lesions
Cord compression
Compound fractures

34
Q

Apart from hyperviscosity, what else does an increase in immunoglobulins result in?

A

Amyloidosis

Hypogammaglobinemia

35
Q

What investigation determines the type of immunoglobulin present in myeloma?

A

Serum electrophoresis

36
Q

What are some of the risk factors for myeloma?

A

The elderly

37
Q

What is myeloma associated with?

A

MGUS
Osteoporosis
Amyloidosis

38
Q

What does MGUS stand for?

A

Monoclonal Gammopathy of Uncertain Significance

39
Q

If you have an increased number of paraproteins, but have no symptoms and are clinically sound, what is the most likely diagnosis?

A

MGUS

40
Q

Immunoglobulins are usually diverse and are sporadic in their arrangement. What do you call a colony of one type of immunoglobulin?

A

Paraproteins

41
Q

Why does fatigue occur in myeloma?

A

As there is an increase in calcium levels, which results in decreased membrane excitability

42
Q

What are the differentials for myeloma?

A

MGUS
Non-Hodgkins lymphoma
Amyloidosis
Leukaemia

43
Q

Cigarettes increase the risk of getting pretty inch every cancer, what is an early sign of cancer in relation to cigarettes?

A

Gradual loss of liking the taste

44
Q

How can MGUS develop into myeloma?

A

As the paraprotein count increases by 1% each year, so will gradually increase you risk of developing myeloma

45
Q

What type of fractures occur in myeloma?

A

Pathological fracture

46
Q

How does myeloma cause spinal cord compression?

A 
Vertebral collapse (due to fractures)
Plasma-cytoma
47
Q

How is spinal cord compression treated?

A 
High-dose steroids (to reduce swelling)
Radiotherapy (if soft tissue mass)
Surgical decompression (if non-soft tissue mass)
48
Q

Before an autologous stem cell transplant, what is given to patients waiting to get one and why?

A

G-CSF

To stimulate stem cell production

49
Q

Mucositis is a complication of chemotherapy, what symptoms can it cause?

A

Mouth pain
GI upset
Diarrhoea

50
Q

If a patient has mucositis, can they receive a stem cell transplant?

A

No

It’s a contraindication

51
Q 
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
A

POEMS syndrome

52
Q

What is the closest treatment of being curative for myeloma?

A

Autologous stem cell transplant

53
Q

Is myeloma curable?

A

Nah mate

54
Q

How long can stem cells from an autologous stem cell transplant be frozen?

A

10 years

55
Q

When you give high-dose steroids, what type of medication do you ALWAYS have to give to prevent GI upset?

A

PPI

56
Q

What are urinary Bence-Jones proteins?

A

Light chains in urine

57
Q

What is a good investigation to look at lytic bone lesions in myeloma?

A

CT skeletal survey

58
Q

Why can a CT skeletal survey be used in myeloma?

A

As contrast is not involved, so it can be used in cases of renal failure (like in myeloma)

59
Q

For PJP prophylaxis, when will Pentamidine be used ahead of cotrimoxazole and why?

A

In situations of BM failure (e.g. post chemo or SCT)

Because cotrimoxazole can cause agranulocytosis

60
Q

What are the morphological signs of myeloma on a BM?

A

> 10% clonal plasma cells
Immature plasma cells
“Clock-face” nuclei
Eccentric nuclei

61
Q

What are the morphological signs of myeloma on a blood film?

A

Rouleaux formation

Circulating plasma cells

62
Q

Give 3 examples of chromosome mutations that can cause myeloma?

A

t(11,14)
11q deletion
13q14 deletion

63
Q

What is the main stay management of myeloma?

A

Batter them with chemo, then give an autologous stem cell transplant

64
Q

What is the triad of clinical features for myeloma?

A

> 10% clonal plasma cells
Lytic bone lesions
Free light chains in urine

65
Q

What injections are given to myeloma patients who have BM failure and are in need of more RBCs?

A

EPO injections

66
Q

What Ig tends to be decreased in hypogammaglobinemia?

A

IgG

Systems- Haematology (26 decks)

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