OnlineMedEd: Hematology Oncology - "Plasma Cell"

Question 1

Multiple myeloma cells make _____________ immunoglobulin.

Answer 1

incomplete

Question 2

Why do those with multiple myeloma get recurrent infections?

Answer 2

The monoclonal cells crowd out the other WBCs.

Question 3

On labs, you’ll see ____________ in someone with multiple myeloma.

Answer 3

a protein gap, serum electrophoresis showing M protein, hypercalcemia, and renal failure

Question 4

The ____________ proteins cause kidney injury.

Answer 4

Bence Jones

Question 5

Explain the rationale for doing a skeletal survey instead of a bone scan in someone with multiple myeloma.

Answer 5

Bone scans (PET-CTs of the bones) pick up metastatic lesions. In multiple myeloma, there are lytic lesions –not mets. Thus, you do a skeletal survey to see the lysis.

Question 6

Review CRAB.

Answer 6

• hyperCalcemia
• Renal failure
• Anemia
• Bone pain/lytic lesions

Question 7

Describe the treatment breakdown for multiple myeloma.

Answer 7

• Older than 70 or with no donor: chemotherapy

* Younger than 70 and with a donor: stem cell transplant

Question 8

Explain the diagnostic workup of monoclonal gammopathy of unknown significance.

Answer 8

MGUS: 
•Serum protein electrophoresis: + 
•Urine protein electrophoresis: -
•Asymptomatic
•Bone marrow biopsy (if done) shows less than 10% plasma cells

Question 9

How is Waldenstrom’s treated?

Answer 9

Rituximab and plasmapharesis

Question 10

Review the diagnostic workup for asymptomatic elevated protein.

Answer 10

•First do a UPEP and skeletal survey
- If either are positive, it’s MM.

•Second do a bone marrow biopsy:

• If it’s less than 10% plasma cells, it’s MGUS
• If it’s greater than 10% plasma cells, it’s MM
• If it’s greater than 10% lymphoplasmacytic cells, it’s Waldenstrom’s