Myeloma ☺️

Question 1

Pathophysiology

Answer 1

Abnormal proliferation of a single clone plasma cell within BM => secretion of monoclonal IgG
-build up of abnormal plasma cells in BM and around body

Question 2

Epidemiology

Presentation

Answer 2

Increases with old age, Afro Carribeans

Pancytopenia - BM infiltrations of myeloma cells
Osteolytic bone lesions (increased osteoclastic activity signalled by myeloma cells) - backpain, pathological fractures
Hypercalcemia
Renal impairment - light chain accumulation in kidneys

Question 3

Investigations

Answer 3

FBC - normocytic normochromic anemia
U&E - signs of AKI, CKD
ALP (LFT) - increased bone turnonver

Blood film
Electrophoresis - look for monoclonal protein bands

Imaging - XRay, CT, MRI => osteolytic lesions, pathological fractures, osteoporosis

Question 4

Management

• supportive
• symptomatic
• curative

Answer 4

Supportive -

• analgesia (avoid NSAIDs due to renal impairment risk)
• bisphosphates - bone protection

Manage symptoms

• transfusion - anemia
• renal failure - fluids, dialysis is an option
• infection - broad spec ABx until cause found

Curative - chemo

Question 5

Complications and how to manage them

Answer 5

Hypercalcemia => rehydrate and bisphosphonates

Spinal cord compression (URGENT MRI) => dexmeth and radio

Hyperviscosity (reduced cognition, visual changes, bleeds) => plasmapheresis to remove light chains

AKI => rehydration