Multiple Myeloma Flashcards
Define Multiple Myeloma?
Haematological malignancy characterised by proliferation of plasma cells resulting in bone lesions and the production of a monoclonal immunoglobulin (paraprotein, usually IgG or IgA)
What is the aetiology of Multiple Myeloma?
Possible viral trigger
Chromosomal aberrations frequent
Associated with ionising radiation, agricultural work or occupational chemical exposures
What is the epidemiology of Multiple Myeloma?
Annual Incidence: 4/100,000
Peak Incidence: 70 yrs
Afro-Caribbean > White People > Asians
What are the presenting symptoms of Multiple Myeloma?
May be an INCIDENTAL finding on routine blood tests Bone Pain Infections (often recurrent) General Symptoms Hyperviscosity symptoms
What bone pain might you see in Multiple Myeloma?
Usually in the back and ribs
Sudden and severe bone pain may be caused by a pathological fracture
What general symptoms might you see in Multiple Myeloma?
Tiredness Thirst Polyuria Nausea Constipation Mental change (due to hypercalcaemia)
What Hyperviscosity symptoms might you see in Multiple Myeloma?
Bleeding
Headaches
Visual Disturbances
What are the signs of Multiple Myeloma on physical examination?
Pallor Tachycardia Flow Murmur Signs of heart failure Dehydration Purpura Hepatosplenomegaly Macroglossia Carpal Tunnel Syndrome Peripheral Neuropathies
What investigations would you do for Multiple Myeloma?
Bloods Blood Film Serum or Urine Electrophoresis Bone Marrow Aspirate and Trephine Chest, Pelvic or Vertebral X-Ray
What bloods would you do for Multiple Myeloma and what might you expect to see?
FBC - low Hb, normochromic normocytic
High ESR (and possible high CRP)
U&Es - high creatinine, high Ca2+
Normal ALP
What would you see on a Blood Film for Multiple Myeloma?
Rouleaux formation with bluish background (suggests high protein)
What would you see on a Serum or Urine Electrophoresis in Multiple Myeloma?
Serum Paraprotein
Bence-Jones Protein
What’s Bence-Jones Protein?
Monoclonal immunoglobulin light chain that’s found in the urine and suggest multiple myeloma
What would you see on a Bone Marrow Aspirate and Trephine in Multiple Myeloma?
High plasma cells (usually > 20%)
What would you see on a Chest, Pelvic or Vertebral X-Ray in Multiple Myeloma?
Osteolytic Lesions without surrounding sclerosis
Pathological fractures
