Myeloma Flashcards
Which race is myeloma more common in?
Afro-Caribbean
What causes plasma cell dyscrasia?
Abnormal proliferation of a single clone of plasma or lymphoplasmacytic cells
How does myeloma cause problems?
Secretion of Ig or and Ig fragment causing dysfunction of many organs
What causes lesions?
Increased osteoclast activation from signalling by myeloma cells
What do osteolytic bone lesions cause?
Pepper pot skull, back pain
Why can you get recurrent bacterial infections?
Neutropenia
What does a positive serum/urine electrophoresis look like?
Ig comes up as a monoclonal band
What type of protein is in urine?
Bence Jones proteins
What are Bence Jones proteins?
Free Ig light chains of kappa or lambda type
What type of formation will RBCs have on a blood film?
Rouleaux - stacking
What imaging would you do?
CT, X-ray
What drug do you give to reduce fracture rates and bone pain?
Bisphosphonate
How would you correct their anaemia?
Transfusions
How would you manage infections?
Treat rapidly with broad-spectrum antibiotics until culture results known
How is myeloma classified?
By Ig product
How many patients have each myeloma type?
2/3 have IgG, 1/3 have IgA, very few have IgD or IgM
What are signs/symptoms of myeloma?
OLD CRAB Old - over 75 Calcium over 2.75 mmol per L Renal impairment Anaemia Bone lesions
What can hypercalcaemia lead to?
AKI
What would you see on an FBC?
Raised ESR, anaemia
What would you see on X-rays?
Pepper pot skull, fractures
What would you see on CT?
Bone lesions, cord compression
Give an example of a bisphosphonate
Zoledronate
What management would you start?
Bisphosphonates, analgesia, radiotherapy, transfusions, infection control, chemo
What analgesia should you avoid?
NSAIDs
What are the two options for chemotherapy?
CTD and VAD
