3. Clinical features
Bone involvement-
Pain & fractures, due to lytic lesions, seen in X-rays of skull, ribs, spine, pelvis
Can cause hypercalcemia
Infection-
LRTI & UTI, due to hypogammaglobulinemia
Renal failure-
Due to hypercalcemia, BJ proteins, amyloidosis, hyperuricemia, UTI
Anemia- N/N, due to BM infiltration
Neurological symptoms-
Weakness, fatigue, confusion due to hypercalcemia
Headache, visual changes due to hyperviscosity
Radicular pain, paraplegia due to spinal cord compression
Carpal tunnel syndrome due to amyloid deposition
Calcium.Renal failure.Anemia.Bone lesions- CRAB
4. Diagnosis
Presence of bone pains/pathological fracture,
anemia, raised ESR & elevated creatinine
raises possibility of MM
Dx- any two of three-
1- Monoclonal M-band in serum electrophoresis
2- BM with >10% plasma cells- CD56,38,138 +ve
3- C.R.A.B
Asymptomatic myeloma-
1 >3 gm% &/or 2, not 3
MGUS- 1 <3 gm%, not 2 or 3
7. Amyloidosis
Variety of conditions characterized by
deposition of amyloid
Amyloid- an altered protein,
with β-pleated sheet structure
Amyloid deposition leads to organ dysfunction
Identified histologically by Congo red staining,
seen as apple-green birefringence under
polarized light
8. Classification
AL- immunoglobulin light chains in MM
AA- amyloid associated protien in chronic
inflammatory diseases- TB, RA, SSA
Transthyretin- senile systemic amyloidosis
β2 microglobulin- long-term hemodialysis
Aβ- brain lesions in Alzheimer disease
Amylin- pancreas of T2DM patients
Calcitonin- medullary carcinoma of thyroid