Plasma Cell Dyscrasias Flashcards
Define Gamma Globulin
class of globulins, identified by their position after serum protein electrophoresis; most significant are immunoglobulins
Define: the small polypeptide subunit of an immunoglobulin
can be classified as either kappa (κ) or lambda (λ)
Light chain
Define : the large polypeptide subunit of an immunoglobulin determines the overall class of each antibody
Heavy Chain
Which two immunoglobulin types fixes complement
IgM and IgG
What does an ABNML kappa:lambda ratio indicate
Plasma cell dyscrasia
What is a plasma cell
A type of immune cell that makes large amounts of a specific antibody.
Develop from B cells that have been activated.
What are the progenitor cells of plasma cells
From Lymphoid Stem Cells -> Lymphoblasts
What defines Monoclonal Gammopathy of Undertemined Sig.
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%)
Dx for MGUS
Serum and Urine electrophoreses
Free light chin assay
Skeletal survey , CBC And Chem (Ca and Cr)
What is the F/u and MGMT for MGUS
Surveillance for at 6 months then annually
-cbc, calcium and Cr level
Red flags for progression of MGUS to Plasma cell myeloma
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)
What is a required workup for Smoldering Myeloma
BONE MARROW Bx
+ low body low dose CT followed by a whole Body MRI
What is the F/u for Smoldering Myeloma
F/u q 3-4 months
Where does Plasma cell myeloma develop from
From the plasma cells of the bone marrow
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
Think of the clin cor pt
Plasma cell myeloma
What are the two ways that plasma cell myeloma effects the kidneys
Light Chain Cast Nephropathy (tamm-horsfall proteins) and Hypercalcemia (renal vasocon)
A pt presents with anemia of chronic dz, elevated serum Ca, evidence of kidney injury/dz, and a rouleaux formation on peripheral smear
Think
Plasma cell myeloma
Order a Serum protein electrophoresis and look for monoclonal spikes (Hallmark of Multiple Myeloma
Spike in Gamma )
What are bence jones proteins
Free light chains in the urine
Found on 24 hour urine for Plasma Cell myeloma
What does CRAB SLIM mean for Plasma cell myeloma
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
