Myelom And Paraproteins

Question 1

What is meant by the term paraprotein?

Answer 1

A monoclonal immunoglobulin present in blood or urine

If it is present, it means there is monoclonal proliferation of a B lymphocyte/plasma cell somewhere else in the body

Question 2

What diseases are paraproteins associated with?

Answer 2

IgM = lymphoma

IgG, IgA = myeloma

Question 3

How does myeloma commonly present?

Answer 3

70th decade, features of: Bone disease (lytic lesions, pathological fractures, cord compression, hyperCalcaemia), bone marrow failure (Anaemia), Renal failure, infections
CRAB acronym

Question 4

What are the principles of diagnosis and treatment of myeloma?

Answer 4

Diagnosed via bone marrow biopsy showing excess plasma cells in the bone marrow

Treatment: 
Chemotherapy
Bisphosphonate therapy 
Radiotherapy
Steroids
Surgery eg pin long bones, decompress spinal cord
Autologous stem cell transplant

Question 5

What tests are used to assess immunoglobulins?

Answer 5

Serum protein electrophoresis IDENTIFIES
Total immunoglobulin levels MEASURES SUBTYPE by heavy chain/Fc section
Immunofixation IDENTIFIES CLASS
Light chains ASSESS IMBALANCE/EXCESS of light chains in urine or serum