Plasma Cell Dyscrasias

Question 1

Define Gamma Globulin

Answer 1

class of globulins, identified by their position after serum protein electrophoresis; most significant are immunoglobulins

Question 2

Define: the small polypeptide subunit of an immunoglobulin

can be classified as either kappa (κ) or lambda (λ)

Answer 2

Light chain

Question 3

Define :  the large polypeptide subunit of an immunoglobulin
determines the overall class of each antibody

Answer 3

Heavy Chain

Question 4

Which two immunoglobulin types fixes complement

Answer 4

IgM and IgG

Question 5

What does an ABNML kappa:lambda ratio indicate

Answer 5

Plasma cell dyscrasia

Question 6

What is a plasma cell

Answer 6

A type of immune cell that makes large amounts of a specific antibody.

Develop from B cells that have been activated.

Question 7

What are the progenitor cells of plasma cells

Answer 7

From Lymphoid Stem Cells -> Lymphoblasts

Question 8

What defines Monoclonal Gammopathy of Undertemined Sig.

Answer 8

Precursor to plasma cell myeloma
-premalingnat

WITH NO END ORGAN DAMAGE

<10% monoclonal plasma cells in the bone marrow

Presents with an M-protein ( IgG 60% and IgA 25%)

Question 9

Dx for MGUS

Answer 9

Serum and Urine electrophoreses
Free light chin assay
Skeletal survey , CBC And Chem (Ca and Cr)

Question 10

What is the F/u and MGMT for MGUS

Answer 10

Surveillance for at 6 months then annually

-cbc, calcium and Cr level

Question 11

Red flags for progression of MGUS to Plasma cell myeloma

Answer 11

Increase in Serum M protein level greater than 50%, or absolute increase greater than 0.5 g/dl

Increase in serum FLC level >50% with a level of at least 100

Any M-protein level greater than 3 g/dl!

or a Urine M protein >500 in 24 hr

INDICATES PROGRESSION TO SMOLDERING MYELOMA
(Greater than 10% monoclonal plasma cells in the bone marrow , with NO END ORGAN DAMAGE)

Question 12

What is a required workup for Smoldering Myeloma

Answer 12

BONE MARROW Bx

+ low body low dose CT followed by a whole Body MRI

Question 13

What is the F/u for Smoldering Myeloma

Answer 13

F/u q 3-4 months

Question 14

Where does Plasma cell myeloma develop from

Answer 14

From the plasma cells of the bone marrow

Question 15

A pt presents with fatigue and anemia type s/s
With bone pain, kidney dz, and a recent infection (pneumonia/ influenza) +peripheral neuropathy!
+/- vertigo, nausea, visual changes, AMS

Think

Answer 15

Think of the clin cor pt

Plasma cell myeloma

Question 16

What are the two ways that plasma cell myeloma effects the kidneys

Answer 16

Light Chain Cast Nephropathy (tamm-horsfall proteins) 
and Hypercalcemia (renal vasocon)

Question 17

A pt presents with anemia of chronic dz, elevated serum Ca, evidence of kidney injury/dz, and a rouleaux formation on peripheral smear

Think

Answer 17

Plasma cell myeloma

Order a Serum protein electrophoresis and look for monoclonal spikes (Hallmark of Multiple Myeloma
Spike in Gamma )

Question 18

What are bence jones proteins

Answer 18

Free light chains in the urine

Found on 24 hour urine for Plasma Cell myeloma

Question 19

What does CRAB SLIM mean for Plasma cell myeloma

Answer 19

Defines the end organ dx for PLM

C-Calcium level >11mg/dl
R-renal insufficiency. CrCl>40 or Seruc Cr >2
A- Anemia, Hgb <10 g/dl
B- Bone lesions, one or more greater than 5mm in size

S-Sixy percent of clonal cells
Li- Light chains, FLC ratio of 100 or more
M-MRI with more than one lesion