Plasma Cell Neoplasms Flashcards
What happens in multiple myeloma?
Expansion of plasma cells in try bone marrow
What can be seen in the peripheral blood on MM patients?
Realuex- stacking of red cells due to bridging of abnormal proteins
What is an M spike?
in a plasma cell neoplasm you will have a monoclonal proliferation of a single type of immunoglobulin in serum electrophoresis analysis
What are some things that need to be evaluated in a patient with newly diagnosed MM?
- CBC with differential
- Chemistry profile
- Calcium levels
- B2-microglobulin
- SPEP, IFX, and quantitative immunoglobulins
What is the purpose of a CBC with differential in newly diagnosed MM patients?
determines degree of cytopenias (anemic)
What is the purpose of a chemistry profile in newly diagnosed MM patients?
assess renal function
What is the purpose of checking calcium levels in newly diagnosed MM patients?
hypercalcemia can occur leading to osteoclastic activity
What is the purpose of checking B2-microglobulin in newly diagnosed MM patients?
prognostic factor
What is the purpose of checking SPEP, IFX, and quantitative immunoglobulins in newly diagnosed MM patients?
includes serum albumin; IFX is essential to id cases with no M spike
quantitative immunoglobulines can quantitate amount of IgG, igM, IgA, IgD separate from SPEP
What is the purpose of checking 24-hr UPEP and IFX in newly diagnosed MM patients?
Bence Jones proteins in urine can damage kidneys
How is MM diagnosed
- M protein in serum or urine
- Marrow clonal plasma cells or plasmacytoma
- related organ or tissue impairment
What does MM relate in physically?
Calcium-hypercalcemia
Renal insufficiency
Anemia
Bone destruction
What does Bone destruction lead to?
- pain
- fractures
- spinal cord compression
What does hypercalcemia lead to?
- altered mental status
- renal insufficiency
How do MM patients present?
- bone pain
- fatigue
- anemia
- renal insufficiency
- hypercalcemia
M-protein on SPE can be seen in what percentage of MM patients?
80%
M-peak on IF of serum or urine can be seen in what percentage of MM patients?
97%
Most MM is of what immunoglobulin type?
G-50%
A-20%
M-20%
light chain only-15%
T or F. Clonal proliferation of plasma cells is a continuum from fairly benign to severe disease
T.
What is the first step in the clonal progression?
MGUS- an abnormal clone of plasma cells producing an abnormal immunoprotein but not causing any damage and M protein is pretty small
about 5% over 80 yo have it
What is the rate of progression of MGUS to monoclonal B cell malignancy?
1%/yr
One step up from MGUS is what?
Smoldering myeloma
How is Smoldering myeloma defined?
M-protein in serum greater than 30g/L (3mg/dl) and/or BM clonal plasma cells over 10%
No related organ or tissue impairment or symptoms (No CRAB)
One step up from smoldering myeloma is what?
symptomatic MM
How is symptomatic MM defined?
- presence of M-protein in serum and/or urine
related organ or tissue impairment
How does MM cause bone disease?
-myeloma cells produce DKK1, leading to increase in RAKL and iL6 by osteoblast progenitor cells
Increased in RANKL and IL6 causes what?
-osteoblast differentiation is blocked and osteoclast maturation is stimulated
