Flashcards in Myeloma Deck (40):
What are antibodies made up of?
2 heavy and 2 light chains
Which antibody usually exists as a pentamer?
Which antibody exists as a dimer?
Which antibodies exist as a monomer?
IgD, IgE, IgG
Which is the most common antibody in the blood?
Which antibody is passed on in breast milk?
What are plasma cells?
Cells that produce lots of antibodies and secrete them into your bloodstream
Which cells exhibit an eccentric clock faced nucleus (nucleus over to one side) on staining?
What does it mean if the patient has a paraproetin?
That they have an underlying clonal B cell disorder
What test do you do to look for paraprotein?
In what region of the electrophoresis do you look for monocolonal antibodies?
After electorphoresis what test do you do to classify the specific antibody that has become multiclonal?
What is normal daily free light chain production?
0.5g per day
If you are producing too many antibody light chains where does the excess go?
Excreted in urine
What is myeloma a cancer of?
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
What is the most common type of myeloma?
What kind of bone lesions do you see in myeloma?
Lytic "punched out" lesions
What cell break down old bone?
What cells build bone?
What type of bone cells are activated in myeloma?
What types of cells are supressed in myeloma?
What are the symptoms of hypercalcaemia?
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.
4. Hypercalcemia and dehydration
5. Drugs (NSAIDs) taken for pain
How do you treat cast nephropathy?
Switch of light chain production with steroids/ chemo
What is the treatment for myeloma?
2. Alykylating agents (cyclophosphamide, melphalan)
3. Novel agents such as thalidomide
4. Monoclonal antibodies
5. Stem cell transplants
How do you monitor the response to treatment in myeloma?
Electrophoresis to look at paraprotein level
What drugs would you give in myeloma to correct hypercalcaemia and bone pain?
What is the most common cause of paraproteins?
Monoclonal Gammopathy of Uncertain Significance
What does the paraprotein level have to be to be MGUS?
Less than 30g/l
What is the risk of MGIS turning into myeloma?
What is Amyloid Lightchain Amyloidosis?
Protein deposition is organs tissues. These then interfere with the organ function and cause damage.
What is the structure of AL amyloid in tissue?
Insoluble beta pleated sheet
How do you diagnose AL amyloid?
Biopsy of the affected area and analysis using congo red stain
What is the stain for amyloid?
What is lymphoplasmacytoid neoplasm?
Clonal disorder of cells intermediate between a lymphocyte and a plasma cell
What is the paraportein in lymphoplasmacytoid neoplas?
What are the clinical features of Waldenstrom’s Macroglobulinaemia (IgM paraprotein)
B cell symtpoms
- Weight loss
- Night sweats
What is the treatment of Waldenstrom’s Macroglobulinaemia (IgM paraprotein)
Plasmapheresis (removed paraprotein from the circulation)