Multiple Myeloma Flashcards
(43 cards)
Symptoms of multiple myeloma
bone pain, fatigue, weakness, weight loss
hypercalcemia,
elevated proteins
renal dysfunction
platelet dysfunction
infections
amyloidosis
lab findings of MM
anemia,
elevated Cr,
hypercalcemia,
monoclonal protein on serum or urine protein electrophoresis.
Urine dipstick protein/quantitative protein analysis discordance.
Plasma cells >10% in bone marrow
elevated ESR
will see low anion gap because of high albumin levels.
what do you see on imaging with MM
Lytic lesions on CT, PET/CT scan, MRI,
on XR osteoporosis, compression fractures or pathological fractures
urine total protein Cr ratio benefits:
looks all protein in urine’ not just albumin which dipstick only detects. Can account for Bence Jone’s proteins or paraproteins leaked in to urine
presence of this lab worsens prognosis for MM
Cr elevation >1.5 worsens prognosis
focal segmental glomerulonephrosis has what on labs:
proteinuria and nephrotic syndrome. no protein gap No hypercalcemia either.
sarcoidosis can have
hyperabsorptive hypercalcemia and granulomatous interstitial nephritis and hypercalciuria that leads to kidney stones and obstructive uropathy.
Does not have differences in dipstick and quantitative methods of proteinuria.
diagnostic criteria for MM
monoclonal protein in serum or urine
>10% clonal plasma cells in bone marrow or soft tissue bone plasmacytoma
end organ damage with CRAB
what does CRAB stand for in MM?
calcium elevation renal insufficiency anemia bone pain (lytic lesions)
diagnostic tests for MM sensitivity are:
serum protein electrophoresis (for M spike) detects and quantifies a presence of a heavy chain immunoglobulin (Ig something) (light Kappa>lambda)
Serum immunofixation increases sensitivity >90% for detecting the M spike in addition to the determining the subtype of immunoglobulin that created the M spike (IgG usually) and if it’s a monoclonal or polyclonal M spike.
Kappa/lambda light chains - detect and quantify presence of light chains and their ratio. >4 is abnormal.
Can multiple myeloma patients not have an M spike on serum electrophoresis?
yes. UP to 20% can have only a urine light chain and they represent 3% of multiple myeloma cases
Three tests for MM
SPEP or UPEP - if there’s an immunoglobulin M protein present
serum immunofixation - tells you the subtype of immunoglobulin and if it’s monoclonal or polyclonal
kappa lambda light chain ratio - detects and quantifies the presence of light chains
what if there’s a negative serum and urine studies but presence of >10 plasma cells and CRAB
pt has non secretory MM MM without secretion of protein in serum
Side effect of lenalidomide
increased risk for VTE
what is MGUS?
monocolonal gammopathy of undetermined significance (MGUS)
definition of MGUS
M protein <3 g/dl and <10% of bone marrow clonal cells and no end organ damage.
asymptomatic and smouldering myeloma definition:
>10% bone marrow clonal cells WITHOUT evidence of organ damage. or by >60% bone marrow clonal cells
multiple myeloma is defined as:
>10% bone marrow clonal cells with evidence of end organ damage or by >60% bone marrow clonal cells
even if you suspect MGUS must get this test to rule in or out definitively
bone marrow biopsy
Next step after diagnosis of MM
needs a skeletal survey
plain radiographs of bones (skeletal survey) are needed to look for lytic lesions (don’t use bone scans- can detect increased osteoblast activity)
light chain amyloidosis manifestations
large tongue restrictive cardiomyopathy and nephrotic syndrome
MGUS surveillance
after established diagnosis of MGUS need to get follow up every 3 to 6 months
then yearly if stable.
when to get skeletal survey
need to get it in monoclonal gammopathies to exclude lytic bone lesions and severe osteopenia
Comparison of MM and spectrum of MGUS, smoldering and Waldenstrom
there is a risk for M type MGUS to progress to Waldenstrom Macroglobulinemia.
