myeloma and paraproteins Flashcards
(14 cards)
What is the function of immunoglobulins
Recognise and bind pathogens
What is the first immunoglobulin produced in response to a pathogen
IgM
What is a paraprotein
Monoclonal immunoglobulin present in the blood or urine
What does the presence of a paraprotein tell us
There is a monoclonal proliferation of a B lymphocyte or plasma cell somewhere in the body
What are IgM paraproteins associated with
Lymphoma - maturing B lymphocytes make IgM at the start of the immune response
What are IgG and IgA paraproteins associated with
Myeloma - mature plasma cells generate these immunoglobulins after isotope switching
What is a myeloma
A cancerous transformation of a plasma cell - causes production of IgG and IgA paraprotein
What are the features seen in myeloma
- Lytic bone lesions
- Pathalogical fracture
- Cord compression
- Hypercalcaeima
- Bone marrow failure such as anaemia
- Infections
CRAB - Hypercalcaemia
- Renal failure
- anaemia
- bone disease
What are the effects of paraprotein
Renal failure (cast nephropathy) and hyperviscosity
What are the clinical features of amyloidosis caused by paraprotein or light chains (AL amyloid)
- Nephrotic syndrome
- Cardiac failure with left ventricular hypertrophy
- Carpal tunnel syndrome
- Autonomic neuropathy
- Cutaneous infiltration
What is required to diagnose myeloma
Excess plasma cells in the bone marrow - >10% of total bone marrow cell population
What is the treatment of myeloma
- Chemo (proteasome inhibtors such as carfilzomib or bortezomib) first line
- Bisphosphonates (zoledronic acid)
- Radiotherapy
- Steroids
- Surgery
- Stem cell transplant
What is the presentation of IgM lymphoma
- Bone marrow failure (anaemia, thrombocytopenia)
- lymphadenopathy
- Hepatosplenomegaly
- B symptoms
What is the test for paraproteins
Serum protein electropheresis
