plasma cell disorders hubbard slides

Question 1

what is the hallmark of plasma cell disorder

Answer 1

isolated peak in gamma region on serum protein electrophoresis representing a single complete immunoglobulin molecule

Question 2

most plasma cell disorders occur in middle aged and older pt the exception is what

Answer 2

heavy chain diseases which can occur in any age gropu

Question 3

what is a less common presenting symptom that can occur with any PCD

Answer 3

periopheral neuropathy

Question 4

in pts with an A:G ratio of what can have a DD of what

Answer 4

<1
albumin to globulin
usually greater
DD: MGUS, meloma, other PCD
(you'll look like a rockstar if you tell your attending this on rounds)

Question 5

what test do you order to confirm multiple myeloma

Answer 5

skeletal xray survey
cant do a bone scan bc osteoblast are inactive
can do imaging study of spine
electrophoresis
-need biopsy of BM

Question 6

3 things for MM

Answer 6

lytic bone lesions
monoclonal paraproteinemia
increased in marrow plasma cells above 10% (must be abnormal looking)

Question 7

treatment for MM

Answer 7

address hypercalcemia
take care of fragile bones with bisphosphonate

initial therapy: thalidomide, lenalidomide,
dexamethasone
(mibs)
bortezommib, carfilzomib

Question 8

what has a big gamma spike and shows suppression of uninvolved immunoglobulin levels

Answer 8

MM

Question 9

how do you manage pt with waldenstrom macroglobenemia

Answer 9

plasmaphoresis
rituximab
single agent bortizamib