6: Myeloma and other plasma cell disorders Flashcards Preview

Haematology Week 3 2018/19 > 6: Myeloma and other plasma cell disorders > Flashcards

Flashcards in 6: Myeloma and other plasma cell disorders Deck (46)
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1

What are the functions of B cells?

Antibody production

Antigen presenting cells

2

What is a terminally differentiated B cell called?

Plasma cell

3

Every antibody has two ___ chains and two ___ chains.

two light chains

two heavy chains

4

What shape is IgM?

Pentamer

Big molecule, so tends to cause hyperviscosity when produced in excess (

5

Where do B cells mature?

Bone marrow

6

By which process are a large variety of B cells produced in the bone marrow?

VDJ recombination

7

After B cells leave the bone marrow, where do they go to be exposed to antigens?

Lymph node follicles

8

Where in the follicle of a lymph node are B cells found?

Germinal centre

9

In what forms are mature B cells found in the

a) bone marrow

b) circulation?

a) Memory B cells

b) Plasma cells

all other B cells are found in the lymph nodes, waiting to be activated

10

How do plasma cells look morphologically?

Fried egg appearance

Nucleus off to the side, deep blue cytoplasm, white Golgi apparatus adhered to nucleus

11

Blood malignancies are (polyclonal / monoclonal).

monoclonal

cells derived from the same dodgy parent cell

12

What causes normal increases in antibody levels?

Infection

Inflammation

Malignancy

13

What is meant by a monoclonal increase in antibodies?

Increase in the clone of a SINGLE B CELL

14

What are monoclonal antibodies also referred to as?

Paraproteins

All the same because they're all produced by the same clone of plasma cells

15

Which investigation is used to separate out the different proteins found in a blood sample?

Serum electrophoresis

16

How does normal serum electrophoresis look?

Variety of bands referring to variety of proteins, none of them abnormally bright

17

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

18

Which type of chain is produced in excess by plasma cells?

Light chains

19

Light chains are produced in excess by plasma cells.

How are these proteins excreted?

Via urine

20

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

21

What is a malignancy of plasma cells called?

Myeloma

22

What is the benign precursor of myeloma called?

MGUS

Monoclonal gammopathy of unknown significance

23

What are the clinical features of myeloma?

Hypercalcaemia symptoms: stones, bones, groans, psych moans

Polydipsia

Renal impairment (reduced eGFR, elevated urea and creatinine)

24

Which types of myeloma are most common?

IgG myeloma

IgA myeloma

25

What is the course of myeloma?

relapsing

26

Why does myeloma cause bony lesions?

Inflammatory cytokines cause OSTEOCLAST activation and OSTEOBLAST suppression

Causing widespread degradation (osteoporsis) and focal lesions

27

Which metabolic disturbance occurs as a result of bone lysis in myeloma?

Hypercalcaemia

bones, stones, groans and psychic moans

28

What is a system commonly damaged by the light chains produced in myeloma?

Renal

Light chains are directly toxic to the kidneys; produce pink casts

29

Pink casts seen in myeloma ___ the renal tubules.

block

30

How is cast nephropathy managed?

Hydration

Stop nephrotoxic drugs (NSAIDs, ACEIs, ARBs, diuretics, gentamicin, metformin)

Immunosuppression to switch off light chain production