Loading....
Coupon Accepted Successfully!

Medicine

Open Flashcards

Hematology

Question
6 out of 29
 

Commonest site of lytic lesion, in multiple myeloma is (AIIMS Nov 2011)



A Vertebral column
B Femur

C Clavicle
D Pelvis

Ans. A

Vertebral column

Clinical Features of Multiple Myeloma

1. The major feature of myeloma is the demonstration of an abnormal monoclonal protein (M protein) in the blood, urine, or both. This M protein usually consists of either one or a combi­nation of heavy chains (lgG and IgA) and light chains (K and λ).

2. Complications occur due to: Infiltration of the marrow by large numbers of plasma cells, which are usually abnormal

a. Anaemia : normocytic and normochromic (Note: leukopenia and thrombocytopenia are rare feature)

b. Weakness, fatigue, infection, and bleeding due to marrow failure

c. Osteolytic lesions(Activation of osteoclast activating factor by IL-6 ) resulting from myeloma-induced bone resorption with subsequent pain (m/c symptom) and fracture. Bone involvement in MM is as follows:

d. Vertebral column > ribs > Skull > Pelvis > Femur > Clavicle > Scapula

e. Renal abnormalities due to myeloma infiltration of the kidney, hypercalcemia, toxic effects of light chains on tubules, amyloid deposition, and hyperuricemia. Urine cast is made up of light chain only (Not a complete immunoglobulin)

In MM patient may developed CRF with enlarge kidney size. Other conditions where patient may have CRF with enlarge kidney size are –

1. Diabeties,

2. Polycystic kidney

3. Amyloidosis

4. Bilateral hydronephrosis (PGI Dec 2008)

f. Recurrent infections due to acquired hypogammaglobulinemia and leukopenia

g. Hypercalcemia due to myeloma-stimulated osteoclast activity. Osteoporosis can occur.

Note:

i. Metastatic calcification occurs

ii. Dystrophic calcifications do not occur.

h. Hyperviscosity due to a high concentration of the M protein which tends to aggregate can cause visual disturbance.

i. Systemic AL amyloidosis.

In MM there is no hepatomegaly, no splenomegaly and no lymph adenopathy.

Compilations of MM

1. Hypercalcemia

2. Spinal cord compression

3. Hyperviscosity syndrome

4. Renal failure

Note: CHF is not a feature of MM:

Table - Clinical Features of Multiple Myeloma (Ref. Hari-18th ed., Pg.- 938, table 111.1)

Clinical Finding

Underlying Cause and Pathogenetic Mechanism

Hypercalcemia, osteoporosis, pathologic fractures, lytic bone lesions, bone pain

Tumor expansion, production of osteoclast activating factor by tumor cells, osteoblast inhibitory factors

Renal failure

Hypercalcemia, light chain deposition, amyloidosis, urate nephropathy, drug toxicity (nonsteroidal anti-inflammatory agents, bisphosphonates), contrast dye

Easy fatigue—anemia

Bone marrow infiltration, production of inhibitory factors, hemolysis, decreased red cell production, decreased erythropoietin levels

Recurrent infections

Hypogammaglobulinemia, low CD4 count, decreased neutrophil migration

Neurologic symptoms

Hyperviscosity, cryoglobulinemia, amyloid deposits, hypercalcemia, nerve compression, anti-neuronal antibody, POEMS syndrome, therapy-related toxicity

Nausea and vomiting

Renal failure, hypercalcemia

Bleeding/clotting disorder

Interference with clotting factors, antibody to clotting factors, amyloid damage of endothelium, platelet dysfunction, antibody coating of platelet, therapy-related hypercoagulable defects

Hematology Flashcard List

29 flashcards
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)