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Haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What are antibodies made up of?

A

2 heavy and 2 light chains

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2
Q

Which antibody usually exists as a pentamer?

A

IgM

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3
Q

Which antibody exists as a dimer?

A

IgA

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4
Q

Which antibodies exist as a monomer?

A

IgD, IgE, IgG

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5
Q

Which is the most common antibody in the blood?

A

IgG

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6
Q

Which antibody is passed on in breast milk?

A

IgA

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7
Q

What are plasma cells?

A

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

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8
Q

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

A

Plasma cell

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9
Q

What does it mean if the patient has a paraproetin?

A

That they have an underlying clonal B cell disorder

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10
Q

What test do you do to look for paraprotein?

A

Serum electrophoresis

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11
Q

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

A

Gamma

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12
Q

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

A

Serum immunofixation

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13
Q

What is normal daily free light chain production?

A

0.5g per day

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14
Q

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

A

Excreted in urine

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15
Q

What is myeloma a cancer of?

A

Plasma cells

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16
Q

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

A
  1. Direct tumour cell effects
    - Bone lesions
    - Increased calcium
    - Bone pain
    - 2. Paraprotein mediated effects
    - Renal failure
    Immune suppression
    Hyperviscosity
    Amyloid
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17
Q

What is the most common type of myeloma?

A

IgG

18
Q

What kind of bone lesions do you see in myeloma?

A

Lytic “punched out” lesions

19
Q

What cell break down old bone?

A

Osteoclasts

20
Q

What cells build bone?

A

Osteoblasts

21
Q

What type of bone cells are activated in myeloma?

A

Osteoclasts

22
Q

What types of cells are supressed in myeloma?

A

Osteoblasts

23
Q

What are the symptoms of hypercalcaemia?

A

Stones
Bones
Abdominal groans
Psychiatric ,moans

Thirst
Dehydration
Renal impairement

24
Q

Why do patients with myeloma get kidney damage?

A
  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
Q

How do you treat cast nephropathy?

A

Switch of light chain production with steroids/ chemo

26
Q

What is the treatment for myeloma?

A
  1. Steroids
  2. Alykylating agents (cyclophosphamide, melphalan)
  3. Novel agents such as thalidomide
  4. Monoclonal antibodies
  5. Stem cell transplants
27
Q

How do you monitor the response to treatment in myeloma?

A

Electrophoresis to look at paraprotein level

28
Q

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

A

Bisphosphonates

29
Q

What is the most common cause of paraproteins?

A

Monoclonal Gammopathy of Uncertain Significance

30
Q

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

A

Less than 30g/l

31
Q

What is the risk of MGIS turning into myeloma?

A

Around 1%

32
Q

What is Amyloid Lightchain Amyloidosis?

A

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

33
Q

What is the structure of AL amyloid in tissue?

A

Insoluble beta pleated sheet

34
Q

How do you diagnose AL amyloid?

A

Biopsy of the affected area and analysis using congo red stain

35
Q

What is the stain for amyloid?

A

Congo red

36
Q

What is lymphoplasmacytoid neoplasm?

A

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

37
Q

What is the paraportein in lymphoplasmacytoid neoplas?

A

IgM

38
Q

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

A 
Hyperviscosity syndrome 
- Fatigue
- Bleeding
- Confusion
B cell symtpoms
- Weight loss
- Night sweats
39
Q

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

A 
Chemotherapy
Plasmapheresis (removed paraprotein from the circulation)
40
Q

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

A

Removes IgM paraprotein and replace with donor plasma

Haematology (21 decks)

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