Myeloma/lymphoma Flashcards
describe the process of b cell development
B cell - pro b cell - immature b cell
move into peripheral circulation as naive B cell - mature in lymphoid tissue
become centroblasts in lymph nodes
what happens to b cells in lymph nodes
become centroblasts and have antigen presented to them and released as either memory b cells or plasma cells
how does a myeloma arise
when a maturing plasma cell is stuck in immature state in bone marrow
what is the role of plasmas cells
produce immunoglobulins
what are the 5 fractions of immunoglobulins
serum albumin a1 globins a2 globins B globins gamam globins
what is the highest normal immunoglobulin fraction
serum albumin
in inflammatory conditions which fractions of Immunglobulins is inrecased
gamma globulins and light increase in others
in neoplastic malignancy which immunoglobulin fraction is rated
releases one protein type (paraprotein) = m spike in one fraction type
what is immunofixation used for
determines what the spike of immunoglobulin is in malignancy during myeloma screen
what is the definition of myeloma
incurable malignant disorder caused by malignant proliferation of plasma cells in the bone marrow
who is commonly affected by myeloma and what is it commonly preceded by
average 70 years - afrocarribean asymptomatic MGUS (monoclonal gammopathy of undetermined significance)
what is the diagnostic criteria for myeloma and what are the features
IMWG criteria clonal bone marrow plasma cells more than 10% CRAB features or MDE's C - hypercalcaemia R - renal insufficiency A - anaemia B - bone lesions
what are the clinical features of myeloma
nephropathy
bone pain, confusion, polyuria, constipation
what investigations can you do for myeloma
bloods (FBS, WBC, Blood film)
U&E
calcium
imaging (skeletal survey)
what is rouleaux
RBC stacked on top of each other
indicates high plasma conc in myeloma or infection
what is a common medical emergency of myeloma
AKI so avoid nephrotoxic drugs
what is AL amyloidosis
rare complication of myeloma - amyloid light chain amyloidosis
deposit fibrins on organs
what condition would you see macroglossia
AL amyloidosis - deposits of amyloid into tongue causing increase in size
where would you see waldenstroms macroglobulinaemia
type of non-hodgkin lymphoma - myeloma - nonPCL progression
what is the definition of lymphoma
malignant proliferation of lymphocytes with predominantly lymph node involvement
what are the two major sub-types of lymphoma
hodgkins - presence of reed sternberg cells
non-hodgkins - non RS cells - non curable but asymptotic
what is follicular lymphoma
indolent non-hoddkin lymphoma
what is the cause and diagnosis tool for follicular lymphoma
increases with age
enlarged lymph nodes caused by acquired t(14:18) causing over expression of BCL2 (protooncogene)
FLIPI ( follicular international prognostic index)
what are the clinal features of hodgkins lymphoma and management
itchy, breathlessness
presence of reed-sternberg cells - chemo and radiotherapy
what are reed-sternberg cells
in hodgkins
fail to express surface immunoglobulin and evade apoptosis
what are the 4 categories of leukaemia
acute/chronic
myeloid / lymphoid
what is the difference between acute/chronic and myeloid/lymphoid
acute - rapid, dramatic presentation, life threatening
chronic - incisors, asymp, don’t always require treatment
myeloid - neutrophils, eosinophils, monocytes, basophils
lymphoid - lymphocytes (B/.T cell)
what is the definition of chronic lymphocytic leukaemia
CLL - malignant disorder of mature B cells in the blood and bone marrow
what is the most common leukaemia in the UK
chronic lymphocytic leukaemia
what are the features, complications and diagnosis of CLL
not always symps splenomegaly, bone marrow failure smudge cells present can mature into advanced lymphoma diagnosed by binet system
what does the binet system measure
Hb levels, platelet levels and lymphadenopathy
