Plasma Cell Disorders

Question 1

Big picture, what is going on with multiple myeloma?

Answer 1

Have this proliferation/mass of plasma cells that is secreting a bunch of different things and causing clinical symptoms depending on the product that is secreted

Question 2

Multiple myeloma is the most common what?

Also, what is the marker elevated in multiple myeloma and what does that marker do?

Answer 2

Primary malignancy of bone

IL6, which is responsible for plasma growth and Ig production

Question 3

What are three products produced and secreted by the plasma cells and what do they cause?

Answer 3

1. Osteoclast activating factor, so bone break down. This occurs especially in the vertebral column and skull. See this punched out lesions on X ray. Leads to bone pain and hypercalcemia.
2. Tons of Ig. See this on SPEP, M spike. Most commonly monoclonal A and G. These duded lack antigen diversity, so infection is most common cause of death in these folks.
3. Huge production and overspill of light chains. They deposit in tissue as amyloid. Also is excreted in urine as bence jones protein. Even deposit in kidney tubules and cause renal failure.

Question 4

What is the effect of the increase in serum protein on RBCs with multiple myeloma?

Answer 4

Decrease charge of RBCs so they aggregate. It’s called rouleaux formation.

Question 5

Explain whats going on with MGUS? What patient population is this most commonly seen in? What is the small risk in these patients?

Answer 5

Have the M spike due to increased serum protein/Ig but none of the symptoms of multiple myeloma.
Elderly, like 70 or above.
Proceed to MM

Question 6

How do we characterize Waldenstrom Macroglobulinemia?

Answer 6

B cell lymphoma producing IgM

Question 7

3 clinical features of macro and one clinical feature of MM that is absent?

Answer 7

Generalized LAD, visual and neuro deficits, bleeding

No bone lesions

Question 8

Why the visual and neuro problems and bleeding problems with macro?

Answer 8

Because IgM is a way bigger Ig, so it causes the blood to be super viscous. The viscosity increase can cause hemorrhaging and also inhibits proper platelet aggregation for clotting.

Question 9

How can we treat acute complications with macro?

Answer 9

Plasmapheresis