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3 Haematology > Myeloma and Plasma Cell Disorders > Flashcards

Myeloma and Plasma Cell Disorders Flashcards

1
Q

how are B cells made

A

derived in bone marrow from pluripotent haematopoietic stem cells

self reactive cells are removed

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2
Q

what roles do B cells have

A

antibody production

acting as antigen presenting cells

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3
Q

what are immunoglobulins

A

antibodies produced by B cells and plasma cells

made up of 2 heavy chains and 2 light chains

each recognises a specific antigen

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4
Q

how to immunoglobulins exit the bone marrow

A

immature B cells with immunoglobulin on their surface axis bone marrow ready to meet their target

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5
Q

what do B cells do in the peripheral

A

travel to the follicle germinal centre of the lymph node

identify the antigen and bind (somatic nutation for a better fit or get deleted if dont fit)

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6
Q

what happens to B cells after they have bound to antigens in the lymph nodes

A

may return to marrow as PLASMA cell

may circulate as a memory B cell

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7
Q

what does a plasma cell do

A

‘factory cell’

pumps out antibodies

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8
Q

characteristics of a plasma cell (histological)

A

eccentric ‘clock face nucleus’

open chromatin synthesising mRNA

lots of blue cytoplasm (full of proteins)

pale perinuclear area (Golgi apparatus)

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9
Q

what is a polyclonal increase in immunoglobulins

A

lots of immunoglobulins produced by different plasma cells

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10
Q

what do polyclonal immunoglobulins react to

A

infection
autoimmune
malignancy
liver disease

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11
Q

what is a monoclonal increase in immunoglobulins

A

lots of immunoglobulins produced all from the same plasma cell

identical antibody structure and specificity

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12
Q

what is a monoclonal immunoglobulin called

A

Paraprotein

a marker of underlying B cell disorder

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13
Q

what test is done to detect immunoglobulins

A

serum electrophoresis (detects abnormal protein bands)

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14
Q

what are free light chains found in circulation

A

because then immunoglobulins are synthesised there are more light chains than heavy chains

the free light chains are secreted into the plasma along with the immunoglobulins

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15
Q

how many free light chains are normally produced per day by plasma cells

A

0.5g

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16
Q

what can cause the amount of free light chains to increase

A

if there is a polyclonal increase in plasma cell numbers (infection)

OR

a monoclonal increase in plasma cells (myeloma)

the free chains overflow into the urine and present as Bence Jones proteins (BJP)

17
Q

what are the causes of paraproteinaemia (monoclonal antibodies)

A

Monoclonal Gammopathy of undetermined significance

Myeloma

Amyloidosis

Lymphoma

Asymptomatic myeloma

Solitary or extra medullary plasmacytoma

chronic lymphocytic leukaemia

others

18
Q

what is myeloma

A

a plasma cell malignancy

19
Q

how does myeloma occur

A

Normal plasma cell

mutation occurs

Monoclonal gammopathy of undetermined significant (benign premalignant phase)

more mutations

asymptomatic myeloma occurs (malignant with no organ damage)

myeloma (malignant)

20
Q

how does myeloma affect the body

A

produces clonal plasma cells which causes

direct tumour cell effects

  • bone lesions
  • increased calcium
  • bone pain
  • replaces normal bone marrow leading to MARROW FAILURE

paraprotein mediated effects

  • renal failure
  • immune suppression
  • hyper viscosity
  • amyloid
21
Q

how is myeloma classified

A

by the type of antibody produced by the monoclonal plasma cells

IgG - most common 
IgA
Bence Jones myeloma (free light chains) 
non-secretory myeloma 
biclonal 
IgD
IgE (v rare)
22
Q

what does lytic bone disease in myeloma look like

A

multiple ‘punched out’ lesions in skull

23
Q

how does myeloma cause lytic bone disease

A

myeloma cells activate osteoclasts in the marrow and suppress osteoblasts

this causes lytic bone disease and increases Ca causing hyperglycaemia

24
Q

how does hypercalcaemia present

A 
stones 
bone 
abdominal groans 
psychiatric moans 
thirst 
dehydration 
renal impairment
25
Q

how does myeloma damage the kidneys

A

tubular cell damage by light chains

light chain deposition - cast nephropathy

sepsis

hypercalcaemia and dehydration

Drugs, NSAIDS

hyperuricaemia

amyloid

3 Haematology (25 decks)

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