Myeloma

Question 1

What is immunoglobulin?

Answer 1

Antibodies

Question 2

What produces antibodies?

Answer 2

B cells - plasma cells

Question 3

What are the 5 types of heavy chains and what immunoglobulin is produced?

Answer 3

Gamma - IgG
Alpha - IgA
Mu - IgM
Delta - IgD
Epsilon - IgE

Question 4

What is the function of IgM?

Answer 4

Initial phase of antibody production - exists as a pentamer with highest molecular weight

Question 5

What is the function of IgA?

Answer 5

Mucous membrane immunity

Question 6

What is the function of IgE?

Answer 6

Parasite immune responses

Hypersensitivity

Question 7

What is paraprotein?

Answer 7

Monoclonal immunoglobulin present in blood or urine

Question 8

What does presence of paraprotein tell us?

Answer 8

Monoclonal proliferation of a B lymphocyte/plasma cell somewhere in the body

Question 9

What is serum protein electropheresis?

Answer 9

Seperates protein based on size and charge - forms characteristic pattern of bands of different widths and intensities based on proteins present

Question 10

What test is used to identify paraprotein?

Answer 10

Electropheresis - assess diversity of antibodies

Question 11

What does total immunoglobulin levels do?

Answer 11

Measures Ig subclasses by heavy chain/Fc section

Question 12

What is immunofixation used for?

Answer 12

Identifying class of paraprotein present

Question 13

What does light chain assessment do?

Answer 13

Assesses imbalance/excess of light chains in urine/serum

Question 14

What paraprotein subtypes are associated with lymphoma?

Answer 14

IgM paraproteins

Question 15

What paraprotein subtypes are associate with myeloma?

Answer 15

IgG

IgA

Question 16

What is myeloma?

Answer 16

Neoplastic disorder of plasma cells, resulting in excessive production of a single type of immunoglobulin

Question 17

What is lymhpoma associated with high IgM?

Answer 17

B lymphocytes produce IgM at start of immune response - higher numbers of b lymphocytes lead to more IgM

Question 18

What is the CRAB mnemonic for features of myeloma?

Answer 18

hyperCalcaemia
Renal failure
Anaemia
Bone disease

Question 19

What are systemic effects of paraprotein?

Answer 19

Renal failure - cast nephropathy
Hyperviscosity
Hypogammaglobulinaemia
Amyloidosis

Question 20

What are features of hyperviscosity?

Answer 20

Bleeding - retinal, oral, nasal, cutaneous
Cardiac failure
Pulmonary congestion
Confusion
Renal failure

Question 21

What is hypogammaglobulinaemia?

Answer 21

Impaired production of normal immunoglobulin leading to increased infections

Question 22

What is amyloidosis?

Answer 22

Group of diseases characterised by deposition of fibrillar protein

Question 23

What are features of amyloidosis?

Answer 23

Nephrotic syndrome
Cardiac failure
Carpal tunnel syndrome
Autonomic neuropathy
Cutaneous infiltration

Question 24

How is amyloidosis diagnosed?

Answer 24

Biopsy of site with amyloidosis

Question 25

How is myeloma diagnosed?

Answer 25

Excess plasma cells in bone marrow - >10% of total bone marrow cell population

Question 26

What is monoclonal gammopathy of uncertain significance? (MGUS)

Answer 26

Paraproteins without any other clinical features

Question 27

What is the most common paraprotein in myeloma?

Answer 27

IgG

Question 28

How is myeloma staged?

Answer 28

Based on albumin and beta-2 microglobulin

Question 29

How is myeloma treated?

Answer 29

Chemotherapy - proteasome inhibitors, Immuno-Modulatory imide Drugs, monoclonal antibodies Bisphosphonate therapy Radiotherapy Steroids Surgery - pinning of long bones, decompession of spinal cord Autologous stem cell transplant