Myeloma and plasma cell dyscrasias Flashcards
what is myeloma
cancer of the plasma cells
common age group
> 65
risk factors for myeloma
○ Male sex
○ Black African ethnicity
○ Family history
Obesity
clinical presentation of myeloma
bone pain ; msot commonly backache
symptoms of anaemia
recurrent infections
symptoms of renal failure
symptoms of hypercalcaemia
symptom control in myeloma
- Opiate analgesia (avoid NSAIDs)
- Local radiotherapy - good for pain relief or spinal cord compression
- Bisphonates - corrects hypercalcaemia and bone pain
Vertebroplasty - inject sterile cement into fractured bone to stabilise
what do bisphosphonates help with in myelom a
corrects hypercalcaemia and bone pain
mainstay of treatment of myeloma
- Combination chemotherapy is the mainstay of treatment
○ Thalidomide in combination with an alkylating agent (e.g. melphalan) and a corticosteroid (e.g. dexamethasone) is first line
Use paraprotein level to monitor response
treatment option for young children who have minimal comorbidities
haematopoietic stem cell transplant
is myeloma curable?
currently seen as an incurable chronic disease - usually takes a relapsing-remitting course, treatment aims to improve quality of life and prolong survival
diagnostic tests for myeloma
bone marrow aspirate and trephine biopsy with plasma cell phenotyping
immunofixation of serum and urine to confirm and show the subtype of the paraprotein
skeletal survey
first line skeletal survey
whole body MRI
ct if mri unsuitable
tests to estimate tumour burden and prognosis
FISH
serum beta 2 microgloublin concentration
initial investigations if myeloma suspected
- Bloods - FBC, U+Es and creatinine, calcium, CRP, plasma viscosity
- Serum protein electrophoresis - shows the type of paraprotein
Plain x-ray of symptomatic areas
how to detect immmunoglobulins
serum electrophoresis
how to classify abnormal protein bands
serum immunofixation
MGUS characteristics
Faulty antibody that shouldn’t be there but isn’t doing any harm – benign
what is paraproteinaemia
medical condition characterised by the presence of abnormal monocloncal proteins which are produced by an overgrowth of a. single clone of plasma cells or other b cells
what do those with MGUS have the potenital to develop
myeloma
paraprotein mediated effects
renal failure
immune suppression
hyperviscosity
amyloid
how can we classify myeloma patients
based on the type of monocloncal protein they produced
majority produce igg
hypercalcaemia characteristics
Stones
Bones
Abdominal groans
Psychiatric moans
Thirst
Dehydration
Renal impairment
diagnostic test for myeloma
bone marrow aspirate and biopsy
how is myeloma identified on bone marrow biopsy
over 10% plasma cells
mneumonic for myeloma
CRAB
calcium
renal failure
anaemia
bone lesions
