Myeloma Etc-Parks

Question 1

What is multiple myeloma?

Answer 1

B cell neoplasm
includes osteolytic bone lesions
see serum monoclonal protein
see monoclonal light chains in the urine–Bence Jones protein

Question 2

Which age group does multiple myeloma usu affect?

Answer 2

older people

70 & older

Question 3

Does it have a good prognosis if left untreated?

Answer 3

no

Question 4

So…how do you get osteolytic lesions in multiple myeloma?

Answer 4

you have these out of control plasma cells that are neoplastic
they secrete osteoclast activating factor
this acts on the RANK receptor of osteoclasts & activates them
the bone is chewed up.
Calcium is released into the blood.
Fracture more possible.
Pain for the patient.

Question 5

What is the recipe of bone & calcium in the bone called?

Answer 5

hydroxyapatite

Question 6

What are some of the problems with hypercalcemia?

Answer 6

kidney stones
heart problems
depression

Question 7

What’s the deal with serum electrophoresis?

Answer 7

you take an agarose gel & use electrophoresis to evaluate normal serum & myeloma serum.
the Igs move thru the gel at different speeds.
If you are using immunoelectrophoresis…you will get this big arc where the IgG or IgAs are high b/c of monoclonal proliferation of a plasma cell.
If you are using serum protein electrophoresis…you will get an M spike (monoclonal).

Question 8

Why is it that those with multiple myeloma are more subject to bacterial infections?

Answer 8

b/c they produce a bunch of monoclonal IgG or IgA, but it doesn’t function properly!!
And ultimately you need humoral immunity to fight bacterial infections.

Question 9

So…even tho malignant plasma cells don’t make good Igs…why aren’t there enough Igs from good plasma cells to make up for it?

Answer 9

b/c the malignant plasma cells secrete substances that suppress the normal IgG or IgA production.

Question 10

What role does urine testing have in multiple myeloma?

Answer 10

the heavy chains of all of the immunoglobulins are disposed of differently, but the light chains are excreted via urine.
get monoclonal light chains or Bence Jones proteins in the urine.

Question 11

Why is it that patients with multiple myeloma can get renal failure?

Answer 11

b/c all of the monoclonal light chains disposed of in the urine are toxic to the tubular lining cells. Can form casts in the tubules.

Question 12

T/F If you see light chains in the urine–means that you have multiple myeloma.

Answer 12

False. Not necessarily. If there are polyclonal light chains–could be lupus or something else.

Question 13

How can hypercalcemia affect kidneys?

Answer 13

affects tubular lining cells

get calcium stones.

Question 14

What percentage of patients with myeloma get renal failure? Renal disease?

Answer 14

Renal Failure: 25%

Renal Disease: 50%

Question 15

A lot of multiple myeloma patients complain of fatigue. Why?

Answer 15

b/c there aren’t the normal erythroblast precursors in the bone marrow. Get anemia.

Question 16

T/F Rouleaux formation is seen in peripheral blood smears of patients with multiple myeloma.

Answer 16

True. the abnormal proteins (Igs) in the blood lower the zeta potential (charge) b/w RBCs. So the RBCs stack like coins.

Question 17

What is cryoglobulin? What is its significance in multiple myeloma?

Answer 17

this is a globulin that coagulates in cold temp. Can cause ischemic tissue necrosis in toes etc.

Question 18

Once again, what are some of the important features of multiple myeloma?

Answer 18

hypercalcemia
lytic bone lesions
pathological fractures
easily fatigued-anemia
recurrent bacterial infections
renal failure
**due hypogammaglobulinemia (not enough functioning Igs)

Question 19

Which chromosome is the culprit for a lot of these neoplasms?

Answer 19

a lot of times translocations with chromosome 14 where the IgH heavy chain is present, which is heavily expressed

Question 20

WHat is another name for Waldenstrom’s macroglobulinemia?

Answer 20

lymphoplasmacytic lymphoma

Question 21

Which cell types do you see a lot of in the blood w/ patients with Waldenstrom’s macroglobulinemia?

Answer 21

plasmacytoid lymphocytes

Question 22

What happens in Waldenstrom’s?

Answer 22

B cell lymphoma
monoclonal proliferation of B cells
get a lot of IgM
the plasmacytoid lymphocytes secrete this.

Question 23

What do you see in the urine of patients with Waldenstrom’s?

Answer 23

lots of IgM light chains. Bence Jones proteins.

Question 24

What is the basic structure of IgM? What is the implication of this structure in patients?

Answer 24

large pentamer

b/c it is so large–causes serum hyper viscosity

Question 25

What is the difference b/w serum & plasma?

Answer 25

serum is the blood plasma w/o the clotting factors

in a patient’s transfusion bag is plasma.

Question 26

What is one way to treat the hyper viscosity of blood in Waldenstrom’s patients?

Answer 26

plasmaphoresis

remove the excess IgM!

Question 27

Give some of the symptoms of blood hyper viscosity in Waldenstrom’s patients.

Answer 27

visual disturbances
dizzy
headaches
altered state of consciousness

Question 28

What does the retina look like in patients with Waldenstrom’s?

Answer 28

thick retinal blood vessels

called the linked sausage effect

Question 29

Is cryoglobulin present in patients with Waldenstrom’s?

Answer 29

Yes, that it why ischemic necrosis is also possible in cold temps in these patients.