RHS29 - White Cell Disorders 3

Question 1

Name the lettered cells

Answer 1

A - band cell

B - monocyte

C - lymphocyte

D - eosinophil (pink granules)

E - Neutrophil (similar to eosinophil but w/out pink granules)

F - basophil (big blue granules)

G - RBC

Question 2

What is multiple myeloma? Which demographic does it usually affect?

Answer 2

A plasma cell neoplasm which involves multiple bones (because plasma cells are in bone marrow).

It typically affects Middle aged and older individuals. It also affects males more frequently than females

Question 3

List the common pathologies caused by multiple myeloma and explain how they’re caused.

Answer 3

• Axial Bone Pain/Pathologic Fracture/Renal Insufficiency - the intermedullary plasma cell proliferation leads to bone destruction causing hypercalcemia (and hypercalcemic nephropathy)
• Bacterial Infections - the marrow replacement leads to cytopenias (particularly neutropenia) and hypogammoglobulinemia (particularly IgG) leaving the patient susceptible to infection
• Organomegaly (spleen, liver, LNs, lung) - probably from hypercalcemia, occurs late in disease course

Question 4

What are the diagnostic criteria for multiple myeloma?

Answer 4

• Presence of myeloma protein (M protein)in the the serum or urine
• Presence of bone marrow clonal plasma cells or plasmacytoma
• Related organ or tissue impairment like hypercalcemia, renal insufficiency, anemia, or bone lesions

Question 5

Describe the histological appearance of multiple myeloma

Answer 5

Plasma cell proliferation seen in a bone marrow aspirate

Question 6

What is myeloma protein and how is it detected?

Answer 6

An abnormal immunoglobulin fragmet of the IgG heave chain (G) and the kappa light chain (κ). It is visualized on serum electrophoresis as a sharp G band and a sharp κ band. These bands are normally diffuse. (see image)

Question 7

What is the prognosis and treatment for multiple myeloma?

Answer 7

• If untreated, death in 1 year
• If treated with alkylating agent chemotherapy, 60% chance of remission, but median survival is still only 3 years
• If younger than 50yo, patient may qualify for allogeneic bone marrow transplant with can extend survival to 10 years