Myeloma & Paraproteins Flashcards Preview

Yr3 Haematology > Myeloma & Paraproteins > Flashcards

Flashcards in Myeloma & Paraproteins Deck (22)
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1

Describe the basic structure of an antibody?

Y shaped with 2 heavy and 2 light chains

"Trunk" = FC portion (constant & defines subclass)

"Branches" = FAB portion (variable & defines antigen binding)

2

What's the most common antibody?

IgG - 75% of total

3

So the heavy chain determines an immunoglobulins subclass. What does the light chain do?

Each cell randomly selects if it will have Kappa or Lambda light chains

Some free light chains can be tested for in the blood to indicate which is more common

4

What is a paraprotein?

A monoclonal Ab in blood or urine (i.e. lots of the same Ab) indicating monoclonal proliferation of a B-cell type

5

How can we test antibody levels?

Total Immunoglobulin levels

6

How do we assess for antibody diversity & paraproteins?

Serum Protein Electrophoresis
(Seperates the proteins incl antibodies by size/charge)

7

How do we determine which class of paraprotein is present?

Immunofixation

8

Light chains aren't detected in electrophoresis but can cause myeloma, how do we test for them?

Light Chain Assay

9

What if we find a paraprotein in someone with no illness?

Diagnose with MGUS
Monoclonal Gammopathy of Uncertain Significance

10

How do we diagnose a myeloma?

Usually indicated by a paraprotein

Then we must find Excess Plasma Cells in the marrow (>10% of total marrow cell pop)

11

How do we stage myeloma?

BAsed on Albumin & Beta2 Microglobulin levels

12

What is a myeloma?

A neoplasm of plasma cells --> Excessive production of a single immunoglobulin

13

Who gets myeloma?

Peaks in the 7th decade
And is commonest amongst black people

14

Presentations of myeloma can occur through Plasma cells or the paraprotein. what could the plasma cells cause?

- Bone disease (Lytic lesions, path fractures, cord compression & hypercalcaemia)
- Marrow failure (esp anaemia)
- Infections

15

What presentations of myeloma can be caused by the paraprotein?

Renal failure (Cast Nephropathy)

Hyperviscosity Syndrome --> Bleeding e.g. retinal, oral, nasal or cutaneous. Sometimes HF, confusion or renal failure

Hypogammaglobulinaemia --> Infections

Amyloidosis

16

How can we treat Myeloma?

Chemo
RT
Bisphosphonate
Steroids
Surgery
Autologous Stem Cell Transplant

17

Why use bisphosphonates in myeloma?

Treat the bone disease, very like osteoporosis

18

What is surgery used for in myeloma?

Pinning long bones and decompressing the spinal cord

19

How does an autologous stem cell transplant work?

ITs not the transplant that treats you, its the chemo:
1) Shrink myeloma as much as possible
2) Harvest healthy stem cells
3) Hardcore chemo destroys myeloma & normal marrow
4) Stem cell transplant (prevents you dying from the marrow damage of chemo)

20

Which immunoglobulins are present in myeloma?

IgA & IgG

IgM paraproteins can be found instead in lymphoma

21

So what is the most common presentation of myeloma?

Bone pain & anaemia
Sometimes with infection, fatigue or renal impairment

22

What tests can you do in myeloma?

Serum protein electrophoresis to identify presence of a paraprotein
Bone marrow aspirate/biopsy (>10% B cells)

Serum Ca, FBC, skeletal survey & U&Es + creatinine are all to assess complications

Albumin & B2 Microglobulins for Staging