Myeloma And Para Proteins Flashcards
What is the primary role of antibodies?
To recognize and bind pathogens
This may directly impede the biological process or direct other components of the immune system by ‘tagging’ the antigen.
What is the basic structure of an immunoglobulin?
Y-shaped with 2 heavy chains and 2 light chains
What defines the Fc portion of an immunoglobulin?
Defined by the heavy chains
What are the five types of heavy chains in immunoglobulins?
- Gamma – IgG
- Alpha – IgA
- Mu – IgM
- Delta – IgD
- Epsilon - IgE
What is the initial phase of antibody production?
IgM
Which immunoglobulin is the most prevalent subclass?
IgG (75% of total)
What is the role of IgA in the immune system?
Mucous membrane immunity
What characterizes a paraprotein?
Monoclonal immunoglobulin present in blood or urine
What does serum protein electrophoresis assess?
Separates protein based on size and charge
What does immunofixation identify?
What class of paraprotein is present (i.e. IgG, IgM)
What is the significance of finding excess plasma cells in the bone marrow?
It indicates myeloma if they comprise > 10% of total bone marrow cell population
What are the clinical features associated with myeloma?
- Bone disease
- Lytic bone lesions
- Pathological fractures
- Cord compression
- Hypercalcaemia
- Bone marrow failure (especially anaemia)
- Infections
What does the acronym CRAB stand for in relation to myeloma?
- Hypercalcaemia
- Renal failure
- Anaemia
- Bone disease
What is the commonest clinical feature of hyperviscosity syndrome?
Bleeding (retinal, oral, nasal, cutaneous)
What does hypogammaglobulinaemia indicate?
Impaired production of normal immunoglobulin
What type of amyloidosis is associated with paraproteins?
AL amyloid
What percentage of the population over age 75 have paraproteins?
3-4%
What is the treatment for symptomatic myeloma?
- Chemotherapy
- Proteasome inhibitors
- IMiDs
- Monoclonal antibodies
- Bisphosphonate therapy
- Radiotherapy
- Steroids
- Surgery
- Autologous stem cell transplant
True or False: IgM paraproteins are associated with low-grade lymphomas.
True
Which immunoglobulin subclass is most commonly associated with myeloma?
IgG (55%)
Fill in the blank: Myeloma is a neoplastic disorder of _______ cells.
plasma
What is the most useful test for possible multiple myeloma?
Serum total electrophoresis
Which of the following is not associated with a paraprotein?
1) Amyloidosis
2) Waldenstrom’s macroglobulinaemia
3) Melanoma
4) MGUS
3) Melanoma
Which statement is true about monoclonal gammopathy of uncertain significance (MGUS)?
1) Most people will not require monitoring
2) The incidence is higher than myeloma
3) Approximately 50% will have lytic bone disease, anaemia, hypercalcaemia or renal failure
4) Only people with an IgD and IgE MGUS require monitoring
1) Most people will not require monitoring
What is the likely diagnosis for a patient with an IgG paraprotein of 7g/l and 12% plasma cells in the bone marrow?
IgG MGUS
What treatment would you provide for a patient who has developed symptomatic myeloma?
- Bortezomib or lenalidomide + steroids
- Hypercalcaemia is managed by fluids/bisphosphonate
- Pain relief (consider radiotherapy)
