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3 Haematology > Plasma Cell Disorders and Myeloma > Flashcards

Plasma Cell Disorders and Myeloma Flashcards

1
Q

what makes antibodies

A

plasma cells

b cells

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2
Q

proteins are made up of how many heavy and light chains

A

2

2

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3
Q

which antibody is a dimer

A

IgA

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4
Q

which antibodies are monomers?

A

IgD
IgE
IgG

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5
Q

what decides what kind of antibody an Ig is going to be?

A

depends on the recombination of the VDJ region

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6
Q

once a B cell leaves a lymph node after fighting infection, what can it become?

A

a memory B cell in ciruclation OR

go back to the marrow as a plasma cell

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7
Q

what do plasma cells do

A

make antibodies

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8
Q

“clock face nucleus” on H and E stain

A

plasma cell

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9
Q

what colour is a plasma cell’s cytoplasm and why?

A

blue as its laden with protein

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10
Q

what is a paraprotein?

A

a monoclonical immunoglobulin

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11
Q

paraproteins are markers of…

A

underlying clonal B cell disorder

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12
Q

how is bence jones protein detected?

A

urine electrophoresis

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13
Q

what is bence jones protein?

A

immunoglobulin light chains

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14
Q

what is the relevance of BJP?

A

high BJP indicates an increase in light chains which = more monoclonal antibodies (myeloma) or more plasma cells

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15
Q

free light chain production by plasma cells is __g per day

A

0.5

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16
Q

what conditions can cause a paraproteinaemia?

A

myeloma
amyloidosis
lymphoma

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17
Q

if myeloma is asymptomatic is it malignant?

A

yes it can be

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18
Q

what 2 aspects of myeloma cause symptoms?

A

direct tumour cell effects

paraprotein mediated effects

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19
Q

symptoms of myeloma that result from the tumour cell?

A

bone lesions
inc calcium
bone pain
marrow failure

20
Q

paraprotein symptoms of myeloma

A

renal failure
immune suppression
hyperviscosity
amyloid deposition

21
Q

most common antibody produced in myeloma

A

IgG

22
Q

“punched out, lytic lesions in the skull”…

A

myeloma

23
Q

how do light chaisn cause renal damage?

A

light chains will be filtered through the glomeruli and form casts in the PCT

24
Q

what kind of fractures are common in myeloma

A

wedge compression vertebral fractures

25
Q

what effect do myeloma cells have on osteoblasts and clasts?

A

decreased osteoblasts

inc osteoclasts

26
Q

symptoms of hypercalcaemia

A 
bones 
stones
moans
groans
thirst
dehydration
renal impairment
27
Q

Tx cast nephropathy in myeloma

A

hydration
stop nephrotoxic drugs
steroids/chemo to switch off light chain production

28
Q

median age of diagnosis of myeloma

A

65

29
Q

Tx myeloma

A

steroids eg dexamethasone/prednisolone
cyclophosphamide
thalidomide/lenalidomide
high dose chemo/stem cell transplant in fit patients

30
Q

how is myeloma monitored?

A

paraprotein levels

31
Q

myeloma tends to relapse T or F

A

T

32
Q

pre-cancer form of myeloma?

A

MGUS

33
Q

symptom control of myeloma?

A

opiate analgesia
radiotherapy
bisphosphonates for bones
vertebroplasty

34
Q

paraprotein level is

A

30

35
Q

how to tell if its MGUS or myeloma?

A

paraprotein <30g/l
bone marrow plasma cells <10%
asymptomatic

36
Q

Ix myeloma

A 
BJP
immunofixation
calcium
renal function
Hb
37
Q

how is the presence of a paraprotein confirmed?

A

immunofixation of serum and urine

38
Q

pathophysiology of AL amyloidosis?

A

mutation in the light chain that causes amyloid to accumulate in the tissues

39
Q

Tx AL amyloidosis

A

chemo

40
Q

AL amyloidosis is a form of familial amyloidosis T or F

A

F different conditions

41
Q

symptoms of AL amyloidosis

A

nephrotic syndrome
cardiomyopathy
organomegaly
malabsorption

42
Q

Ix AL amylodosis

A

urinalysis
organ biopsy with congo red stain
SAP scan to look for other organ involvement

43
Q

what is waldenstrom’s macroglobulinaemia?

A

neoplasm of cells that are an intermediate between lymphocytes and plasma cells

44
Q

presence of IgM paraprotein….

A

waldenstroms macroglobulinaemia

45
Q

signs of waldenstroms

A 
lymphadenopathy
splenomegaly
marrow failure
hyperviscosity
neuropathy
46
Q

symptoms of waldenstroms

A 
fatigue
visual disturbance
confusion
coma
bleeding
heart failure
b symptoms eg night sweats, w loss
47
Q

Tx waldenstroms

A

chemo

plasmaphoresis - removing IgM

3 Haematology (30 decks)

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