Lets talk about Plasma Cell Disorders

Bone marrow biopsy demonstrating sheets of malignant plasma cells in multiple myeloma

Amyloidosis infiltrating the tongue in multiple myeloma

Radiograph of the skull demonstrating a typical lytic lesion in multiple myeloma

Yeah, Its Wednesday and I have nothing better to do than study Plasma Cell Disorders. He is at work so I cannot even talk to him. I already called him like 4 times to talk to him but No ANSWER!!!! But, at least I am getting something done. I am at home racing through these lectures. I am definitely going to have to workout today. Get 200 calories burned on the treadmill. So I weigh 125lbs and I used to weigh 110lbs. That's a lot of pounds to lose. I have become a "Food Lover" and at times obsessive. But then again, I don't eat that much. I think I just need to trim the fat away by running more. What do you all think?

PLASMA CELL DISORDERS:

--> MULTIPLE MYELOMA(MM):

• overproduction of abnormal plasma cells
• 3 primary disease processes: expanding plasma cell mass, overproduction of monoclonal immunoglobulins, & production of OAF and cytokines (IL9)
• effects of monoclonal gammopathy: hyperviscosity syndrome, bence-jones proteins, amyloidosis
• effects of Osteoclast Activating Factor (OAF) and cytokines: bone destruction, lytic lesions, hypercalcemia
• BM biopsy: taken @ 2 different sites, usually >10% plasma cells (min) & >30% (max) seen in MM
• Protein Electrophoresis: indicates a presence of monoclonal spike
• Immunoelectrophoresis: specifies the type of monoclonal spike (ex: IgM or IgG)
• Chemistry tests: BUN and Creatinie for kidney function (should be high), LDH is high, Calcium is high, uric acid is high, albumin is low
• 2 reliable markers of MM: Beta1 microglobulin & C-Reactive Protein

--> SMOLDERING MYELOMA:

• Low mass MM
• Normal kidney function, serum calcium
• No lytic bone lesions

-->SOLITARY PLASMOCYTOMA:

• Single tumor found outside the BM
• BM contains <10%>
• treatment: radiation therapy

-->PLASMA CELL LEUKEMIA:

• rare, presence of significant number of plasma cells in peripheral blood (PB)
• >20% plasma cells in the differential
• less bone pain than MM, organ infiltration is excessive, no hyperviscosity syndrome
• low hgb/hct; leukocytosis; thrombocytopenia; rouleax; high BUN and creatinine

-->MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE (MGUS):

• small M-spike on serum protein electrophoresis
• small amount of urine light chains
• no lytic bone lesions
• <10%>

-->WALDENSTROM'S MACROGLOBULINEMIA (WM):

• overproduction of monoclonal IgM antibodies by cells called plasmacytoid lymphocytes
• fatigue, weakness, weight loss, plasmacytoid lymphocytes infiltrate nerves, meninges, and brain
• prominent feature: hyperviscosity syndrome (retinopathy)
• cryoglobulins: IgM that precipitate on exposure to cold; bleeding form gums and nose; cryoglobulinemic purpura; abnormal coagulation tests,raynaud's phenomena
• no cure; chemo + plasmaphoresis

-->HEAVY CHAIN DISEASE:

• very rare
• excessive production of heavy chain portion of antibody unit
• plasma cells have lost the ability to synthesize the light chain component
• so far IgG, IgA, IGM cases have been reported