Paraproteinaemias

Question 1

Multiple myeloma

Answer 1

clonal proliferation of Plasma cells –> large increase in Ig (commonly IgG/A)

Clone produce IL-6 which promote osteoblas and inhibit clasts

Question 2

Signs and Symptoms

Answer 2

Osteolytic Bone lesions (IL-6): Pain and fractures, vertebral collapse

BM infiltration
Neutropaenia leading to recurrent bacterial infectiond

Renal impairment due to deposition of Light chaind, Amyloid and increase Ca.

Question 3

Investigations of MM

Answer 3

FBC - Anaemia, ESR, Urine (increase specific gravity)
BM Bx and skeletal survey

Bx shows >10% plasma cells in BM

End Organ Damage: CRAB
C - Ca increase
R - Renal Insufficiency
A - Anaemia
B - Bone Leasion

Question 4

Management of MM

Answer 4

Supprotive: Analgsia for Bone Pain - avoid NSAIDs
+ bisphosphinates

Anaemia = Transfusion and EPO
Hydrate + dialysis for Renal Impairment 
Broad Spectrum Abx and IVIg if recurrent infection 
may need to Pin Long Bones
Auto SCT

Chemo - Proteasome inhibitors and monoclonal Abs