October 8, 2015 - Multiple Myeloma

Question 1

Polyclonal Gammopathy

Answer 1

An increase in gammaglobins, but they are different.

Question 2

Monoclonal Gammopathy

Answer 2

An increase in gammoglobins, but all of the same kind. This is not good and can indicate cancer.

Question 3

Multiple Myeloma

Answer 3

A bone marrow cancer with a monoclonal proliferation of plasma cells. Usually producing a monoclonal protein.

Symptoms include bone pain, anemia, hypercalcemia, renal failure, tumor masses, and recurrent infection.

Commonly see anemia with Rouleaux (stacking)

Question 4

Complications of Multiple Myeloma

Answer 4

Skeletal destruction including lytic lesions, pathological fractures, plasmacytomas, and hypercalcemia (from bone breakdown).

Monoclonal proteins in the urine (from renal failure), in the blood, and in the tissue (amyloidosis).

Marrow infilitration resulting in anemia.

Reduction of normal immune globulins due to lack of room leading to infection which is commonly a cause of death.

Question 5

Rouleaux

Answer 5

Stacking of red blood cells in the periphery. Can be indicitive of multiple myeloma.

Question 6

Investigations for Multiple Myeloma

Answer 6

Serum protein electrophoresis

24-hour urine (UPEP)

Serum free light chains

IgA, IgM, IgG

CBC, albumin, B-2 microglobulin

Question 7

Treatment for Multiple Myeloma

Answer 7

Chemotherapy

Corticosteroids

Proteosome inhibitors

Immunological therapies

Stem cell transplants

Question 8

Monoclonal Gammopathy of Undetermined Significance (MGUS)

Answer 8

Higher levels of monoclonal than normal, but not pathological.

Less than 10% plasma cells in the bone marrow.

Less than 30 g/L

1%/year will transform.

Question 9

AL Amyloidosis

Answer 9

Amyloid Light-chain (AL) amyloidosis.

Inappropriately folded antibodies are deposited in tissue and organs. This causes a shitload of problems. This is incurable and treatment is mainly supportive care.