Myeloma Flashcards Preview

Haematology > Myeloma > Flashcards

Flashcards in Myeloma Deck (40):
1

What are antibodies made up of?

2 heavy and 2 light chains

2

Which antibody usually exists as a pentamer?

IgM

3

Which antibody exists as a dimer?

IgA

4

Which antibodies exist as a monomer?

IgD, IgE, IgG

5

Which is the most common antibody in the blood?

IgG

6

Which antibody is passed on in breast milk?

IgA

7

What are plasma cells?

Cells that produce lots of antibodies and secrete them into your bloodstream

8

Which cells exhibit an eccentric clock faced nucleus (nucleus over to one side) on staining?

Plasma cell

9

What does it mean if the patient has a paraproetin?

That they have an underlying clonal B cell disorder

10

What test do you do to look for paraprotein?

Serum electrophoresis

11

In what region of the electrophoresis do you look for monocolonal antibodies?

Gamma

12

After electorphoresis what test do you do to classify the specific antibody that has become multiclonal?

Serum immunofixation

13

What is normal daily free light chain production?

0.5g per day

14

If you are producing too many antibody light chains where does the excess go?

Excreted in urine

15

What is myeloma a cancer of?

Plasma cells

16

What are the two reasons why m=patients with multiple myeloma get ill?

1. Direct tumour cell effects
- Bone lesions
- Increased calcium
- Bone pain
- 2. Paraprotein mediated effects
- Renal failure
Immune suppression
Hyperviscosity
Amyloid

17

What is the most common type of myeloma?

IgG

18

What kind of bone lesions do you see in myeloma?

Lytic "punched out" lesions

19

What cell break down old bone?

Osteoclasts

20

What cells build bone?

Osteoblasts

21

What type of bone cells are activated in myeloma?

Osteoclasts

22

What types of cells are supressed in myeloma?

Osteoblasts

23

What are the symptoms of hypercalcaemia?

Stones
Bones
Abdominal groans
Psychiatric ,moans

Thirst
Dehydration
Renal impairement

24

Why do patients with myeloma get kidney damage?

1. Tubular cell damage by light chains (more light chains = worse kidney damage)
2. Light chain deposition resulting in cast nephropathy.
3. Sepsis
4. Hypercalcemia and dehydration
5. Drugs (NSAIDs) taken for pain
6. Amyloid

25

How do you treat cast nephropathy?

Switch of light chain production with steroids/ chemo

26

What is the treatment for myeloma?

1. Steroids
2. Alykylating agents (cyclophosphamide, melphalan)
3. Novel agents such as thalidomide
4. Monoclonal antibodies
5. Stem cell transplants

27

How do you monitor the response to treatment in myeloma?

Electrophoresis to look at paraprotein level

28

What drugs would you give in myeloma to correct hypercalcaemia and bone pain?

Bisphosphonates

29

What is the most common cause of paraproteins?

Monoclonal Gammopathy of Uncertain Significance

30

What does the paraprotein level have to be to be MGUS?

Less than 30g/l

31

What is the risk of MGIS turning into myeloma?

Around 1%

32

What is Amyloid Lightchain Amyloidosis?

Protein deposition is organs tissues. These then interfere with the organ function and cause damage.

33

What is the structure of AL amyloid in tissue?

Insoluble beta pleated sheet

34

How do you diagnose AL amyloid?

Biopsy of the affected area and analysis using congo red stain

35

What is the stain for amyloid?

Congo red

36

What is lymphoplasmacytoid neoplasm?

Clonal disorder of cells intermediate between a lymphocyte and a plasma cell

37

What is the paraportein in lymphoplasmacytoid neoplas?

IgM

38

What are the clinical features of Waldenstrom’s Macroglobulinaemia 
(IgM paraprotein)

Hyperviscosity syndrome
- Fatigue
- Bleeding
- Confusion
B cell symtpoms
- Weight loss
- Night sweats

39

What is the treatment of Waldenstrom’s Macroglobulinaemia
(IgM paraprotein)

Chemotherapy
Plasmapheresis (removed paraprotein from the circulation)

40

What does plasmaphoresis do in Waldenstrom’s Macroglobulinaemia
(IgM paraprotein)?

Removes IgM paraprotein and replace with donor plasma