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Haematology > Myeloma and Paraproteins > Flashcards

Myeloma and Paraproteins Flashcards

1
Q

Antibodies are produced by which type of cell?

A

B cell - plasma cell

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2
Q

Function of antibodies

A

Recognise and bind pathogens

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3
Q

How many heavy chains does an antibody have?

A

2

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4
Q

How many types of heavy chains are there?

A

5 - IgG, IgM, IgA, IgD, IgE

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5
Q

How many light chains does an antibody have?

A

2

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6
Q

Which antibody heavy chain exists as a pentamer?

A

IgM

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7
Q

Which antibody heavy chain has the highest molecular weight?

A

IgM

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8
Q

Which antibody heavy chain is involved in the initial stage of antibody production?

A

IgM

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9
Q

Which heavy chain is the most prevalent antibody subclass?

A

IgG

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10
Q

Which heavy chain is invovled in mucous membrane immunity?

A

IgA

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11
Q

IgE heavy chain antibodies are involved in which immune responses?

A

Parasite immune responses

Hypersensitivity

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12
Q

Name 2 types of light chain

A

Kappa or Lambda

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13
Q

How are light chains selected for each cell?

A

Random

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14
Q

How many types of light chains will antibodies have produced by one cell>

A

One cell produces one specific light chain with one specificity

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15
Q

Which type of antibody chain can be found free and at low levels in the blood?

A

Light chain

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16
Q

What does immunoglobulin total levels indicate?

A

The number of immunoglobulin subclasses

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17
Q

What is a paraprotein?

A

Identical antibodies, produced via a clonal process
Monoclonal immunoglobulin present in blood or urine //CSF
Monoclonal proliferation of B cell/plasma cell somewhere in the body

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18
Q

What can be used to diagnose presence of paraproteins?

A

Serum Protein electrophoresis

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19
Q

How does serum protein electrophoresis identify paraproteins?

A

Separates proteins according to size and charge to illicit a band pattern

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20
Q

Other tests used to assess paraproteins

A 
Immunofixation - identifies class
Light chains - imbalance/excess of light chains in urine/serum
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21
Q

IgM paraproteins are associated with which disease?

A

Lymphoma

22
Q

Lymphoma can be characterised by presence of which type of paraprotein?

A

IgM

23
Q

IgM antibodies are produced by which cells and which stage of immune response?

A

Maturing B lymphocytes at beginning of immune response

24
Q

Myeloma is associated with which paraproteins?

A

IgA

IgG

25
Q

IgA and IgG paraproteins are produced by which cells

A

Plasma cells after isotype switching

26
Q

Myeloma is a neoplastic disorder of which type of cell?

A

Plasma cell

27
Q

Myeloma occurs in which 2 groups of the population>

A

Those in 7th decade

Black population

28
Q

Clinical features of myeloma

A

Bone Disease
Bone Marrow Failure
Infections

CRAB- hypercalcaemia, renal disease, anaemia, bone disease

29
Q

Describe the 4 features of bone disease found in cases of myeloma

A

Lytic lesions - salt pepper skull
Pathological fractures
Cord compression
Hypercalcaemia

30
Q

Describe the appearance of the skull in case of myeloma

A

Salt pepper skull

Lytic lesions

31
Q

How does renal failure occur due to paraproteins?

A

Cast nephropathy

IgG deposits- blocks renal tubules

32
Q

Four Effects of paraproteins

A

Renal Failure
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis

33
Q

Hyperviscosity causes bleeding in which four tissues in particular?

A

Retinal, oral, nasal and cutaneous

34
Q

4 Clinical consequences of hyperviscosity

A

Renal failure
Cardiac failure
Pulmonary congestion
Confusion

35
Q

Hypogammaglobulinaemia has which clinical consequence

A

Tendency for infection

36
Q

Which type of protein forms deposits in amyloidosis

A

Fibrillar protein

37
Q

Amyloidosis is given which name when caused by paraproteins or light chains

A

Amyloid Light-chain Amyloidosis (AL)
OR
Primary amyloidosis

38
Q

Amyloidosis is a feature of which 5 conditions

A 
Nephrotic syndrome
Cardiac Failure - LVH
Carpal tunnel syndrome
Autonomic neuropathy
Cutaneous infiltration
39
Q

Paraprotein can trigger inflammation leading to which condition

A

Amyloidosis

40
Q

Amyloidosis is typically triggered by which type of conditions

A

Inflammatory - RA, TB

41
Q

Paraproteins are common and can lead to which diagnosis

A

Monoclonal Gammopathy of Uncertain Significance (MGUS)

42
Q

Criteria for Myeloma diagnosis

A

Excess plasma cells in bone marrow

>10% of population of cells

43
Q

Criteria for Asymptomatic Myeloma diagnosis

A

Paraprotein + >10% cells

No CRAB symptoms

44
Q

What are CRAB symptoms for Myeloma?

A

Hypercalcaemia
Renal disease
Anaemia
Bone disease

45
Q

Most common type of paraprotein (55%)

A

IgG

Followed by IgA, Light chain only

46
Q

Staging of paraprotein is based on?

A

Albumin and beta 2 microglobulin

47
Q

Treatment of Myeloma

A 
Chemotherapy
Radiotherapy
Bisphosphonate therapy - zoledronic acid
Steroids
Surgery
Autologous stem cell transplant
48
Q

What is used in chemotherapy in the treatment of myeloma?

A

Proteasome inhibitors - carfilzomib, bortezomib
IMiDs (lenalidomide,
pomalidomide)
Monoclonal antibodies

49
Q

What surgery is involved in treatment of myeloma?

A

Pinning of long bones

Decompression of the spinal cord

50
Q

Clinical presentation of lymphoma

A 
Lymphadenopathy
Bone marrow failure
Hepatosplenomegaly
B symptoms
Paraprotein related symptoms
51
Q

What are B symptoms?

A

Fever, weight loss, fatigue, pruritus, drenching night sweats

52
Q

What symptoms are rare with lymphomas?

A

Bone disease

Haematology (7 decks)

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