Myeloma and other plasma dyscrasia Flashcards
These cells have an eccentric ‘clock face nucleus’ on H&E
Plasma cells
What is a paraprotein?
A monoclonal immunoglobulin
Marker of underlying clonal B cell disorder
Paraprotein
Method to detect immunoglobulins
Serum electrophoresis
Most negatively charges molecule in electrophoresis
Albumin (so will be closest to anode)
Most positively charged molecule in electrophoresis
Alpha-1 band (predominantly contains alpha 1 antitrypsin) so will be furthest from anode
How many g of free light chain is produced by normal plasma cells in a day
0.5g
Effect of IL6 on osteoblasts and osteoclasts
- increase osteoclast activity
- decrease osteoblast activity
Which cells in the kidney are damaged by light chains?
Tubular cells
What does light chain deposition cause?
Cast nephropathy
- damage ~may~ be reversible with prompt treatment
- switch off light chain production with steroids/chemo
How can you monitor response to treatment in myeloma?
Measure paraprotein level
What is monoclonal gammopathy of uncertain significance? (MGUS)
Paraprotein
Diagnosis of AL amyloidosis
Organ biopsy confirming AL amyloid deposition- congo red stain
(rectal or fat biopsy may be done if high clinical suspicion - less invasive)
Which stain do you use when doing myeloma biopsy
Congo red
“apple green birefringence” under polarised light
AL amyloidosis
