2. Malignant clonal proliferation of b-lymphocyte plasma
cells
Normal: different plasma cells produce different
Immunoglobulin w/c are polyclonal
Myeloma: single clone of plasma cell produce identical
Immunoglobulin- seen as monoclonal band or
paraprotein
4. Symptoms
Do serum protein electrophoresis & ESR on ALL >50yo
with BACKPAIN
Osteolytic bone lesions- backache, pathological fx &
vertebral collapse
Anemia, neutropenia & thrombocytopenia- results
from marrow infiltration by plasma cells
5. Symptoms
Recurrent bacterial infections: due to immunoparesis
and neutropenia
Renal impairment due to light chain deposition
precipitation of,light chains with the TammHorsfall
protein in the distal loop of henle
Monoclonal Ig induce changes in the glomeruli
6. test
CBC: NCNC anemia
PBF: Rouleaux formation
high ESR
High Urea & Crea
High Ca
Normal ALP
7. Screening Test: serum & urine electrophoresis
B2 microglobulin: as a prognostic test
XRAY: punch-out lytic lesions
8. Myeloma Diagnostic Criteria
Monoclonal protein band in serum/urine
electrophoresis
Increase plasma cell in BMA biopsy
Evidence of end organ damage from MYELOMA:
1. Hypercalcemia
2. Renal insufficiency
3. anemia
9. treatment
Supportive:
Bonepain: analgesia, avoid NSAIDs
Bisphosphonates: to tx hypercalcemia acutely
Anemia: should be corrected with transfusion &
Erythropeitin
Renal failure: rehydrate, ensure 3L/day
Infections: broadspectrum ABX until C/S is out
10. Chemotx: if unsuitable for intensive tx
Melphalan + Prednisone
11. prognosis
Median survival: 3-4years
High b2- microglobulin worse prognosis
Death infection/ renal failure