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Y3 Haematology > Paraproteinaemias / Myeloma > Flashcards

Paraproteinaemias / Myeloma Flashcards

1
Q

Polyclonal raised immunoglobulins is due to a _____ cause

Monoclonal raised immunoglobulins is due to a _____ cause

A

Polyclonal = reactive

Monoclonal = B cell problem

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2
Q

What test is done to detect serum Ig? What test is then done to identify the type of Ig?

A

Electrophoresis

Then serum immunofixation

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3
Q

What is a paraprotein?

A

Monoglonal Ig in blood or urine

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4
Q

Name the causes of paraproteinaemia

A 
MGUS
Myeloma
Amyloidosis
Lymphoma
CLL
Waldenstrom's macroglobulinaemia
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5
Q

What is MGUS?

A

Monoclonal gammopathy of unknown significance - myeloma precursor

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6
Q

MGUS is common / uncommon in the elderly. What % a year become myeloma?

A

Common

1%

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7
Q

What is serum Ca and Hb in MGUS?

A

Normal

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8
Q

What is the average age of myeloma patients?

A

65

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9
Q

What are the tumour related S+S in myeloma?

A 
Hypercalcaemia
Lytic bone lesions
Pancytopeania
Bone pain
SC compression
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10
Q

What are the paraprotein related S+S in myeloma?

A

Renal failure
Immune suppression
Hyperviscosity
Amyloid

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11
Q

How does hypercalcaemia present?

A 
Kidney stones
Bone pain 
Psychiatric moans
Abdominal groans (constipation)
Thirst
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12
Q

In myeloma the ____ are mutated causing excess _____ productions

A

Mutated plasma cell

Light chains

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13
Q

What causes myeloma nephropathy

A

Light chains are toxic to renal tubules

Light chains clump together forming renal casts that block the tubule

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14
Q

Myeloma can be classified by the antibodies produced, what are the 3 most common ones? Which Ig is never produced?

A

IgG, IgA, BJP

Never IgM

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15
Q

What test diagnostic of myeloma?

A

Urine electrophoresis light chains Bence Jones Protein

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16
Q

How is myeloma monitored?

A

Paraprotein level

17
Q

What is the management of myeloma? What drug class should be avoided?

A

CCS + combination chemo

Avoid NSAIDs

COULD GO INTO LOADS MORE DETAIL

18
Q

What causes AL amyloidosis?

A

Mutated light chain causes paraproteins; clump as insoluble beta sheets and accumulate in organs

19
Q

What organs are affected by AL amyloidosis?

A

Cardiomyopathy
Nephrotic synd
Liver
Autonomic/ peripheral neuropathy

20
Q

What test is diagnostic of AL amyloidosis?

A

Congo red stain polarised light apple green birefringence

21
Q

What is the management of AL amyloidosis?

A

Chemotherapy

22
Q

What causes Waldenstrom’s macroglobulinaemia?

A

Lymphoplasmacytic type NHL, pentameric IgM paraprotein

23
Q

How does Waldenstrom’s macroglobulinaemia present?

A 
Hyperviscosity
B cell S+S
Neuropathy
Lymphadenopathy
Marrow failure
Splenomegaly

DO WE REALLY NEED TO KNOW THIS?

24
Q

How does hyperviscosity present?

A 
Fatigue
Vision disturbance
Confusion
HF
Bleed
Coma
25
Q

What is the management of Waldenstrom’s macroglobulinaemia?

A

Chemotherapy + plasmapharesis

Y3 Haematology (15 decks)

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