Haematology: multiple myeloma

Clinical presentation Common * bone pain and pathological fractures * anaemia(bonemarrowfailure) * recurrent infections (due to immunoparesis) * hypercalcaemia * renal failure (multiple aetiologies: hypercalcaemia, light chain deposition, non-steroidal drugs, anaemia, infections) * abnormal bleeding...

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Bibliographic Details
Published in:Clinical medicine (London, England) England), 2019-01, Vol.19 (1), p.57-60
Main Author: Firth, John
Format: Article
Language:English
Subjects:
Anemia
Bisphosphonates
Bone marrow
Chemotherapy
CME Medical masterclass
Immunoglobulins
Infections
Medical prognosis
Multiple myeloma
Pain
Patients
Proteins
Radiation therapy
Transplants & implants
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Summary:Clinical presentation Common * bone pain and pathological fractures * anaemia(bonemarrowfailure) * recurrent infections (due to immunoparesis) * hypercalcaemia * renal failure (multiple aetiologies: hypercalcaemia, light chain deposition, non-steroidal drugs, anaemia, infections) * abnormal bleeding (due to platelet dysfunction) Rare * hyperviscosity syndrome (ischaemia, heart failure and neurological problems) * amyloid disease (eg carpal tunnel syndrome) Investigations If myeloma is suspected, the following tests may be useful. * FBC can reveal normochromic, normocyticanaemia. * Erythrocyte sedimentation rate (ESR) is raised (the positive charge of the protein neutralises the negative charge of sialic acid on the erythrocyte membrane, reducing their natural tendency to repulse each other and causing the cells to fall faster in a column). * Biochemistry can show raised calcium (usually with a normal alkaline phosphatase) and renal impairment. * Serum electrophoresis may demonstrate a monoclonal protein. Differential diagnosis of a serum paraprotein Malignant * Waldenström's macroglobulinaemia * lymphoma * chroniclymphocyticleukaemia * primary amyloidosis * plasma cell leukaemia Benign/stable * monoclonal gammopathy of uncertain significance * AIDS Treatment Myeloma may present as an acute emergency: * acute kidney injury: prompt treatment of volume depletion is critical; involve the nephrologists early * hypercalcaemia: fluids and bisphosphonates are critical * spinal cord compression: a radiotherapy emergency * hyperviscosity: consider plasmapheresis. [...]autologous transplants may also be performed, often with good results.
ISSN:1470-2118
1473-4893
DOI:10.7861/clinmedicine.19-1-58