PLASMA CELL MYELOMA

Question 1

Multiple myrloms

Answer 1

Cancer affecting the plasma cells in the bone marrow

Question 2

Complications of multiple myeloma

Answer 2

Impaired ability to fight infections
Hyperviscosity
Renal failure
Erosion of bone with resultant
Peripheral blood cytopaenias
Osteolytic lesions
Pathological fractures
hypercalcaemia

Question 3

Precipitants of multiple myeloma

Answer 3

Chemicals e.g. dioxins, formaldehyde, and nitrobenzene found in solvents and cleaning agents
Ionizing radiation
Viruses e.g. Herpes Virus 8, Epstein-Barr, HIV, Hepatitis Virus

Question 4

Symptoms of multiple myeloma

Answer 4

Bone pain
Easy fatiguability
Excessive weakness
Recurrent infections
Bony swellings

Question 5

Signs of multiple myeloma

Answer 5

Pallor
Fever
Dehydration
Bony lumps
Paraplegia
Paresis
Renal Impairment
Unprovoked fractures

Question 6

Investigations in multiple myeloma

Answer 6

FBC and blood film comment
ESR
Blood urea, electrolytes, creatinine
Plasma calcium levels
Serum uric acid
Bone marrow aspirate
Skeletal survey including skull X-ray
Serum protein levels
Serum protein electrophoresis
Urine Bence Jones protein

Question 7

Treatment objectives in multiple myeloma

Answer 7

To reduce the number of abnormal plasma cells to normal and reduce their rate of increase
To treat anaemia
To reduce bone pain
To manage pathological fracture
To improve or maintain good bone mineral density
To treat infections
To prevent and treat renal complications

Question 7

Non-pharmacological interventions in multiple myeloma patients include

Answer 7

Patients should drink at least 3 litres of fluid each day throughout the course of their disease
Physiotherapy
Orthopaedic supports

Question 8

Pharmacological approaches in multiple myeloma

Answer 8

To reduce number of plasma cells and rate of increase
Chemotherapy

To reduce bone pain
Pain relief (avoid NSAIDS)

To treat anaemia
Packed red cells transfusion and platelet transfusion when indicated

To prevent and treat renal complications
IV and oral fluids

To mitigate tumour lysis
Allopurinol to mitigate tumour lysis

To treat infections
Antibiotics