Myeloma And Paraproteins

Question 1

What are the 5 antibodies

Answer 1

IgG (gamma)
IgA (alpha)
IgM (Mu)
IgD (delta)
IgE (epsilon)

Question 2

What are the 2 types of light chains

Answer 2

Kappa

Lambda

Question 3

What does the Fab region of an immunoglobulin define

Answer 3

Target binding site

Question 4

What does the Fc region of an immunoglobulin define?

Answer 4

Subclass

Question 5

Immunoglobulin total levels

Answer 5

IgG: 6-15g/l
IgA: 1-4.5g/l
IgM: 0.5-2g/l

Question 6

What is a paraprotein and what does it tell us?

Answer 6

A paraprotein is a monoclonal immunoglobulin present in the blood or urine

If present tells us that there is a monoclonal proliferation of a B lymphocyte/ plasma cell somewhere in the body

Question 7

What does serum protein electroheresis do?

Answer 7

Separates protein based on size and charge,

Forms a characteristic pattern of bands of different widths and intensities based on proteins present

Question 8

Summary of tests in serum protein electrophoresis

Answer 8

Total immunoglobulin levels
-measures Ig subclasses by Fc section

Electrophoresis

• assesses antibody diversity
• identifies paraprotein

Immunofixation
-indentifies class of paraprotein 

Light Chain
-Assesses imbalance/ excess of light chains in urine/serum

Question 9

What do IgM paraproteins indicate?

Answer 9

Lymphoma

Maturing B lymphocytes make IgM antibody at start of immune response

Question 10

What doe IgG and IgG paraproteins indicate

Answer 10

Myeloma

Mature plasma cells generate these types of immunoglobulin after isotope switching

Question 11

What is a myeloma

Answer 11

Neoplastic disorder of plasma cells, resulting in excessive production of a single type of immunoglobulin (eg paraprotein)

Question 12

Risk factors for myeloma

Answer 12

7th decade

Ethnicity- commoner in black population

Question 13

Myeloma features

Answer 13

CRAB
hyperCalcaemia
Renal failure 
Anaemia 
Bone disease 

Bone disease:
-lytic bone lesions (salt and pepper bones)
-pathological fractures, 
-cord compression 
-hypercalcaemia 
Bone marrow failure 
Infections

Question 14

Effects of the paraprotein in myeloma

Answer 14

Renal failure- cast nephropathy (Ig deposition and blockage of renal tubules)

Hyperviscosity (causes bleeding- retinal, oral, nasal, cutaneous) (can also cause cardiac failure, pulmonary congestion, confusion, renal failure)

Hypogammaglobulinaemia (impaired production of normal immunoglobulin)

Amyloidosis (deposition of fibrillar protein)

Question 15

What does amyloidosis result in?

Answer 15

Nephrotic syndrome, 
Cardiac failure, 
Carpal tunnel syndrome, 
Autonomic neuropathy, 
Cutaneous infiltration

Question 16

Diagnosis of myeloma

Answer 16

Paraproteins (though over 75 could be normal and termed Monoclonal gammopathy of uncertain significance (MGUS))

Excess plasma cells in bone marrow

Question 17

Types of paraprotein in myeloma

Answer 17

IgG,
IgA,
Light chains only,
Other (IgD, non secretory)

NO SUCH THING AS IgM MYELOMA

Question 18

What is stage of myeloma based on?

Answer 18

Albumin and beta-2 microglobulin

Question 19

Myeloma treatment

Answer 19

Chemotherapy (proteasome inhibitors, IMiDs)
Bisphosphonate therapy (zoledronic acid)
radiotherapy,
Steroids, 
Surgery,
Autologous stem cell transplant