What are the functions of B cells?
Antigen presenting cells
What is a terminally differentiated B cell called?
Every antibody has two ___ chains and two ___ chains.
two light chains
two heavy chains
What shape is IgM?
Big molecule, so tends to cause hyperviscosity when produced in excess (
Where do B cells mature?
By which process are a large variety of B cells produced in the bone marrow?
After B cells leave the bone marrow, where do they go to be exposed to antigens?
Lymph node follicles
Where in the follicle of a lymph node are B cells found?
In what forms are mature B cells found in the
a) bone marrow
a) Memory B cells
b) Plasma cells
all other B cells are found in the lymph nodes, waiting to be activated
How do plasma cells look morphologically?
Fried egg appearance
Nucleus off to the side, deep blue cytoplasm, white Golgi apparatus adhered to nucleus
Blood malignancies are (polyclonal / monoclonal).
cells derived from the same dodgy parent cell
What causes normal increases in antibody levels?
What is meant by a monoclonal increase in antibodies?
Increase in the clone of a SINGLE B CELL
What are monoclonal antibodies also referred to as?
All the same because they're all produced by the same clone of plasma cells
Which investigation is used to separate out the different proteins found in a blood sample?
How does normal serum electrophoresis look?
Variety of bands referring to variety of proteins, none of them abnormally bright
How does serum electrophoresis look if there is a monoclonal increase in antibody levels?
Bands corresponding to paraproteins will be super bright
representing that there's a ton of them being produced by a single clone of plasma cells
Which type of chain is produced in excess by plasma cells?
Light chains are produced in excess by plasma cells.
How are these proteins excreted?
What are light chains called when they are produced in excess and excreted via the urine?
Bence Jones protein
A sign of myeloma (and other diseases causing increased paraproteins) found using urine electrophoresis
What is a malignancy of plasma cells called?
What is the benign precursor of myeloma called?
Monoclonal gammopathy of unknown significance
What are the clinical features of myeloma?
Hypercalcaemia symptoms: stones, bones, groans, psych moans
Renal impairment (reduced eGFR, elevated urea and creatinine)
Which types of myeloma are most common?
What is the course of myeloma?
Why does myeloma cause bony lesions?
Inflammatory cytokines cause OSTEOCLAST activation and OSTEOBLAST suppression
Causing widespread degradation (osteoporsis) and focal lesions
Which metabolic disturbance occurs as a result of bone lysis in myeloma?
bones, stones, groans and psychic moans
What is a system commonly damaged by the light chains produced in myeloma?
Light chains are directly toxic to the kidneys; produce pink casts
Pink casts seen in myeloma ___ the renal tubules.
How is cast nephropathy managed?
Stop nephrotoxic drugs (NSAIDs, ACEIs, ARBs, diuretics, gentamicin, metformin)
Immunosuppression to switch off light chain production