My Patients Flashcards
Multiple Myeloma – which interleukin may be increased?
IL-6
Txs that treat Hyperkalemia by increasing its excretion from the body?
- Kayexylate (exchanges Na for K in gut)
- Diuretics (furosemide)
- Dialysis
Txs that treat Hyperkalemia by driving K+ into cells?
- Insulin
- Bicarbonate (use esp. if acidemic drives K into cells in exchange for H)
- β-2 agonists
Most common primary malignancy of bone?
Multiple Myeloma
note: only “primary” – otherwise most common would be bone mets
How does Multiple Myeloma cause bone lesions?
Neoplastic cells activate RANK (osteoclast activating factor), activating osteoclasts which cause lytic “punched out” lesions that can be seen on X-ray, esp. in vertebrae & skull (inc’d risk of fracture)
What does “SPEP” stand for?
Serum Protein ElectroPhoresis
“M spike” in Multiple Myeloma is seen via what procedure? What is the “M spike”?
SPEP will show M spike of monoclonal antibodies, which are usually IgG or IgA
Why is the M spike problematic in Multiple Myeloma patients?
B/c monoclonal antibodies lack genetic diversity, so you are left susceptible to many other infections
Most common cause of death in Multiple Myeloma?
Infection
due to monoclonal antibodies lacking genetic diversity
What is seen on RBC smear in Multiple Myeloma & why?
- Rouleax Formation: RBCs pile up on each other like “poker chips” due to the fact that the increased serum protein decreases charge between RBCs
- Also a marked increase in ESR
Likely urine findings in Multiple Myeloma?
Bence Jones proteins: free immunoglobulin light chains (either kappa or λ) that are often found in significant quantities in the urine
Serum chemistry changes in Multiple Myeloma?
- Hypercalcemia (2ary to bone destruction)
- Alkaline phosphatase is NOT increased (in contrast to most cases of hypercalcemia)
- Anemia (due to neoplastic encroachment on myeloid precursors)
& possibly:
- Leukopenia
- Thrombocytopenia
Dx?
B-cell neoplasm of lymphoid cells that produce a monoclonal IgM protein.
Waldenstrom Macroglobulinemia (similar to MM, but no bone lesions)
What other organ system might likely be affected by Multiple Myeloma & how so?
Renal insufficiency w/ azotemia due to myeloma kidney (myeloma nephrosis).
The renal lesion is characterized by prominent tubular casts of Bence Jones protein, numerous multinucleate macrophage-derived giant cells, & metastatic calcification, & sometimes by interstitial infiltration of malignant plasma cells
What is amyloid?
- Abnormally folded protein w/ a β-pleated sheet configuration
- deposits extracellularly, usually near BM
- Amorphous, eosinophilic appearance in routine hematoxylin & eosin sections
- Stained w/ Congo Red dye, demonstrating apple-green birefringence (other stains work too)
