Myeloma (zero to finals) Flashcards
(32 cards)
What is myeloma?
Myeloma is a type of cancer affecting the plasma cells in the bone marrow.
Plasma cells are B lymphocytes that produce antibodies.
What does cancer in a specific type of plasma cell cause?
Results in the production of large quantities of a specific paraprotein (or M protein), which is an abnormal antibody or part of an antibody.
What is multiple myeloma?
Multiple myeloma is where the myeloma affects multiple bone marrow areas in the body.
What are plasma cells?
B lymphocytes of the immune system that have developed to produce a specific antibody.
Antibodies are also called immunoglobulins.
They are complex molecules made up of heavy chains and light chains arranged in a Y shape.
What is another name for antibodies and what are the 5 types?
Also called immunoglobulins.
The five types of antibodies are A, G, M, D and E.
Role of the antibodies?
They help the immune system recognise and fight infections by targeting specific proteins on the pathogen.
What paraprotein does myeloma produce?
Myeloma is cancer of a single type of plasma cell, with a genetic mutation that causes them to rapidly and uncontrollably multiply.
They produce a specific paraprotein (or M protein), which is an abnormal antibody (immunoglobulin) or part of an antibody (often the light chain).
There is an abnormally high level of this paraprotein (paraproteinaemia).
What are Bence Jones proteins?
The Bence Jones protein refers to free light chains in the urine.
What are the 4 main features of myeloma (mnemonic: CRAB)?
C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain
What is the most common complication of myeloma?
Anaemia
How does myeloma lead to anaemia?
The cancerous plasma cells invade the bone marrow (bone marrow infiltration), resulting in suppression of the other blood cell lines, leading to:
Anaemia (low haemoglobin)
Leukopenia (low white blood cells) Thrombocytopenia (low platelets)
What type of anaemia is present in myeloma?
Anaemia in myeloma is normocytic (normal size) and normochromic (normal colour).
What is the pathology behind myeloma bone disease?
From increased osteoclast activity and suppressed osteoblast activity.
Osteoclasts absorb bone, and osteoblasts deposit bone.
The metabolism of bone becomes imbalanced, with more bone being reabsorbed than constructed.
What is the cause of myeloma bone disease?
Caused by cytokines released from abnormal plasma cells and other nearby cells.
Common sites of myeloma bone disease?
Skull, spine, long bones and ribs.
Patients with myeloma often develop renal impairment, what are some of the various causes?
Paraproteins deposited in the kidneys
Hypercalcaemia affecting kidney function
Dehydration
Glomerulonephritis (inflammation around the glomerulus and nephron)
Medications used to treat the condition
What is the range for normal plasma viscosity?
The normal plasma viscosity, or internal friction in blood flow, is between 1.3 and 1.7 times that of water.
Meaning blood should be 1.3-1.7x thicker than water.
What can increase the plasma viscosity?
Plasma viscosity increases when more proteins are in the blood, such as the paraproteins found in myeloma.
Hyperviscosity syndrome is an emergency, what are some of the issues it can cause?
Bleeding (e.g., nosebleeds and bleeding gums)
Visual symptoms and eye changes (e.g., retinal haemorrhages)
Neurological complications (e.g., stroke)
Heart failure
Risk factors for myeloma?
Older age
Male
Black ethnic origin
Family history
Obesity
What are clinical features that would raise suspicion of myeloma?
Persistent bone pain (e.g., spinal pain)
Pathological fractures
Unexplained fatigue
Unexplained weight loss
Fever of unknown origin
Hypercalcaemia
Anaemia
Renal impairment
What is the list of lab investigations that can be done for myeloma?
FBC (anaemia or leukopenia in myeloma)
Calcium (raised in myeloma)
ESR (increased in myeloma)
Plasma viscosity (increased in myeloma)
U&E (for renal impairment)
Serum protein electrophoresis (to detect paraproteinaemia)
Serum-free light-chain assay (to detect abnormally abundant light chains)
Urine protein electrophoresis (to detect the Bence-Jones protein)
What investigation is required for a myeloma diagnosis?
Bone marrow biopsy is required to confirm the diagnosis and perform cytogenetic testing.
Why is imaging done for myeloma and what is the order they are done in?
Imaging is used to assess for bone lesions. The order of preference is:
- Whole-body MRI
- Whole-body low-dose CT
- Skeletal survey (x-ray images of the entire skeleton)
