Plasma Cell Disorders (Dyscrasias) Flashcards
What are 6 clinical features of multiple myeloma?
- Bone pain with hypercalcemia; RANK receptor on osteoclasts activated. Punched out lytic skeletal lesions on X ray
- Elevated serum protein - neoplastic cells produce immunoglobulin. M spike is present on serum protein electrophoresis. Monoclonal IgG or IgA
- Increased infection risk due to lack of antigenic diversity
- Rouleaux formation of RBCs on blood smear due to decreased charge between RBCs
- Primary AL amyloidosis
- Proteinuria - Bence Jones protein due to free light chain excretion in urine
What is multiple myeloma? What is elevated in the blood work? What does this thing do?
Malignant proliferation of plasma cells in the bone marrow. High serum IL-6 may be present. Stimulates plasma cell growth and immunoglobulin production.
You see a 70 year old patient. Lab work shows increased serum protein with M spike on SPEP. What diseases could he have? X ray shows no lytic bone lesions, no hypercalcemia, no AL amyloid or Bence Jones Proteinuria. What is it now? What is he at risk of?
Either Multiple myeloma or monoclonal gammopathy or undetermined significance (MGUS).
He has MGUS.
1% of pts develop multiple myeloma.
A 37 year old policewoman comes to your clinic for her annual checkup. Physical exam shows generalized lymphadenopathy. X ray shows no bone lesions. Blood work shows increased serum protein with M spike comprised of IgM. She mentioned that her vision has been getting worse the past couple of months. Neuro exam shows reduced function in several categories. Why does she have hyper serum viscosity? What does this lead to? What does she have? How would you treat her?
She has Waldenstrom macroglobulinemia which is a B cell lymphoma with monoclonal IgM production. She has serum hyper viscosity due to IgM which is a large pentamer. This results in deceive platelet aggregation and bleeding. Tx with plasmapheresis to treat IgM from the serum.
A patient comes to your office with complaints of bleeding from the nos and gums. She also mentions that she has been fatigues and is losing weight. Physical exam shows splenomegaly. Other notable findings include M spike on lab work. What could she be having?
Waldenstrom macroglobulinemia
