Plasma Cell Disorders

Question 1

Plasma Cells

Answer 1

Fully differentiated B cells that make Immunoglobulin.

Question 2

Structure of Immunoglobulins.

Answer 2

2 heavy chains and 2 light chains.

Question 3

Types of light chains.

Answer 3

Kappa and lambda.

Question 4

Types of heavy chains.

Answer 4

G, A, M, E, D.

Question 5

Rules of making an Ig.

Answer 5

An Ig can only be made of one type of heavy chain and one type of light chain.

Question 6

Classification of Plasma Cell Disorders (WHO Classification).

Answer 6

(1) Monocloncal Gammopathy of Undetermined Significance (MGUS).
(2) Plasma Cell myeloma.
(3) Plasmacytoma.

Question 7

Connects the two heavy chains to one another and the two light chains to one another.

Answer 7

Disulfide bonds.

Question 8

IgM

Answer 8

Detected first in the body after a primary antigenic stimulus.
It’s a macroglobulin, so it’s too big to cross the placenta.

Question 9

IgD

Answer 9

Very little in the serum.

Question 10

IgA

Answer 10

Found in external secretions (bowel).

Question 11

IgE

Answer 11

The one that you get when you have allergic reactions - has immediate hypersensitivity.

Question 12

IgG

Answer 12

The main Ig in the blood. Detected after a second exposure to an antigen.
It crosses the placenta.

Question 13

How to identify plasma cells in a histo section?

Answer 13

Clock-faced chromatin.

Question 14

“M” Protein

Answer 14

A “monoclonal” serum protein made by neoplastic plasma cells or B lymphocytes.

Question 15

Definition of clonal.

Answer 15

Derived from one cell of origin.

Question 16

Monoclonal gammopathy

Answer 16

A neoplastic plasma cell produces plasma cells that are all neoplastic and have the exact same type of light and heavy chains.

Question 17

What do monoclonal gammopathies produce and secrete into the blood?

Answer 17

M protein.

Question 18

How do monoclonal plasma cells stain?

Answer 18

All the cells would stain one color. If there’s a mixture of colors, then it’s a polyclonal population.

Question 19

SPEP

Answer 19

Serum Protein Electrophoresis

Question 20

Test for a monoclonal serum protein.

Answer 20

Serum protein electrophoresis.

Question 21

The 5 regions of a normal serum protein electrophoresis.

Answer 21

Albumin (highest), alpha1, alpha2, beta, and gamma.

Question 22

What an abnormal SPEP looks like.

Answer 22

Goal Posts spike.

Question 23

Major protein in the blood.

Answer 23

Albumin.

Question 24

Done whenever you’re trying to figure out if there’s an abnormal protein in the blood.

Answer 24

SPEP.

Question 25

Identifies monoclonal proteins in the serum or urine.

Answer 25

Immunofixation Electrophoresis.

Question 26

Proteins are separated in the urine or serum and them incubated with specific antisera against Ig's of interest.

Answer 26

Immunofixation Electrophoresis

Question 27

Is Monoclonal Gammopathy of Undetermined Significance considered neoplastic?

Answer 27

No

Question 28

Risk of progression of MGUS.

Answer 28

1.6%/year

Question 29

Age population of MGUS

Answer 29

Elderly.

Question 30

Plasmacytoma

Answer 30

A discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue.

Question 31

Myeloma

Answer 31

An osteolytic cancerous tumor in the bone marrow.

Question 32

Plasmacytomas have a normal....

Answer 32

bone marrow biopsy.

Question 33

Symptoms of plasmocytomas.

Answer 33

Swelling/bone pain.

Question 34

Myeloma presents as...

Answer 34

osteolytic bone lesions and abnormal marrow.

Question 35

Plasma cell myeloma is AKA

Answer 35

Multiple myeloma.

Question 36

Cells with eccentric nuclei are?

Answer 36

Plasma cells.

Question 37

CRAB

Answer 37

Signs of organ or tissue impairment with multiple myeloma: Hypercalcemia, Renal failure, Anemia, Bone lesions.

Question 38

Asymptomatic plasma cell myeloma.

Answer 38

Has no signs of CRAB.

Question 39

What is kidney damage caused by in plasma cell myeloma?

Answer 39

Excessive Ig.

Question 40

Where is plasma cell myeloma often found?

Answer 40

Vertebra, skull, scapula, ribs.

Question 41

What does a gross specimen of multiple myeloma look like?

Answer 41

Punched out osteolytic lesions, and juicy, red color.

Question 42

What don't you see in normal plasma cells?

Answer 42

Nucleoli

Question 43

Seen in normal plasma cells and myeloma cells.

Answer 43

Russell bodies, which are Ig inclusions.

Question 44

Red blood cells and multiple myeloma.

Answer 44

The RBC's in multiple myeloma are stacked, and this is called Rouleaux.

Question 45

What is Rouleaux caused by?

Answer 45

Increased serum protein.

Question 46

When a smear has Rouleaux, what disease could it be?

Answer 46

Plasma cell myeloma.

Question 47

Bence Jones proteins

Answer 47

Monoclonal light chains in the urine.

Question 48

Cause damage to the kidney as a result of multiple myeloma.

Answer 48

1) Monoclonal light chains form tubular casts. 2) Plasma cell infiltration. 3) Hypercalcemia makes calcium deposits. 4) Amyloid deposition.

Question 49

Il-6

Answer 49

Promotes myeloma proliferation.

Question 50

Role of bisphosphonates

Answer 50

Inhibit bone resorption/lysis by getting rid of osteoclasts.