Multiple myeloma - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2019-12-11T02:47:05Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Anemia DDX}}		{{Anemia DDX}}
			{{Bone tumors and their mimics DDX}}

	==Evaluation==		==Evaluation==

2019-12-10T06:21:03Z

Evaluation

← Older revision		Revision as of 06:21, 10 December 2019
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	==Evaluation==		==Evaluation==
			[[File:Plasmozytom multiple Osteolysen Unterarm.png\|thumb\|X-ray of the forearm, with lytic lesions]]
	*Definitive diagnosis is by biopsy of marrow or plasmacytoma		*Definitive diagnosis is by biopsy of marrow or plasmacytoma
	*CBC		*CBC

2019-11-20T22:39:22Z

Evaluation

← Older revision		Revision as of 22:39, 20 November 2019
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	*BMP, ionized Ca, Mg, phos		*BMP, ionized Ca, Mg, phos
	**Paraproteins bind calcium, so non-ionized Ca levels could be falsely elevated		**Paraproteins bind calcium, so non-ionized Ca levels could be falsely elevated
			**Pseudohyponatremia from paraproteinemia
			**Hyperphosphatemia from increased bone turnover
	*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)		*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)
	**SPEP and UPEP electrophoresis		**SPEP and UPEP electrophoresis

2019-11-20T22:37:47Z

Evaluation

← Older revision		Revision as of 22:37, 20 November 2019
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	**Paraproteins bind calcium, so non-ionized Ca levels could be falsely elevated		**Paraproteins bind calcium, so non-ionized Ca levels could be falsely elevated
	*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)		*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)
	**SPEP and UPEP electrophoresis, Bence Jones protein		**SPEP and UPEP electrophoresis
	*~~mMost~~ common monoclonal proteins in order are as follows: IgG, IgA, Kappa > lambda light chains		**Urine analysis will show large, waxy, laminated casts due to monoclonal proteins known as Bence Jones proteinuria
			***Urine dipstick will be negative for protein as it detects albumin rather than monoclonal proteins
			*Most common monoclonal proteins in order are as follows: IgG, IgA, Kappa > lambda light chains
	*Other work up contingent on presentation:		*Other work up contingent on presentation:
	**MRI spine: low threshold if any clinical evidence of cord compression		**MRI spine: low threshold if any clinical evidence of cord compression
	**Plain films of suspected pathologic fractures		**Plain films of suspected pathologic fractures
	**Infectious work up		**Infectious work up
			**ECG can show shortened QT interval secondary to hypercalcemia

	==Management==		==Management==

2019-11-20T22:35:45Z

Evaluation

← Older revision		Revision as of 22:35, 20 November 2019
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	*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)		*Serum and urine testing for monoclonal protein (to aid in initial diagnosis if patient not already known to have MM)
	**SPEP and UPEP electrophoresis, Bence Jones protein		**SPEP and UPEP electrophoresis, Bence Jones protein
			*mMost common monoclonal proteins in order are as follows: IgG, IgA, Kappa > lambda light chains
	*Other work up contingent on presentation:		*Other work up contingent on presentation:
	**MRI spine: low threshold if any clinical evidence of cord compression		**MRI spine: low threshold if any clinical evidence of cord compression

2019-11-20T22:33:32Z

Clinical Features

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	**Often on immunosuppressive chemotherapy or bone marrow transplant meds		**Often on immunosuppressive chemotherapy or bone marrow transplant meds
	**Splinting due to rib pain/fractures increased pneumonia risk		**Splinting due to rib pain/fractures increased pneumonia risk
			*Coagulopathy can occur due to dysfibrinogenemia

	[[File:Lyticlesionfracture.png\|thumbnail\|Pathological fracture from lytic lesion]]		[[File:Lyticlesionfracture.png\|thumbnail\|Pathological fracture from lytic lesion]]

2019-11-20T22:32:07Z

Clinical Features

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	**[[Hyperviscosity syndrome ]]		**[[Hyperviscosity syndrome ]]
	***Increase serum viscosity due to paraproteins poor capillary flow and organ congestion		***Increase serum viscosity due to paraproteins poor capillary flow and organ congestion
			***Cryoglobulinemic vasculitis
			****Altered mental status, syncope, stroke
	**Rouleaux formation on peripheral smear		**Rouleaux formation on peripheral smear
	*Neuro		*Neuro

2019-11-20T22:30:46Z

Clinical Features

← Older revision		Revision as of 22:30, 20 November 2019
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	**Though overall uncommon as first presentation finding		**Though overall uncommon as first presentation finding
	*[[Infection]]		*[[Infection]]
			**Most common cause of death in patients with multiple myeloma
	**Impaired plasma cell function decreased effective antibody production		**Impaired plasma cell function decreased effective antibody production
	**Often on immunosuppressive chemotherapy or bone marrow transplant meds		**Often on immunosuppressive chemotherapy or bone marrow transplant meds

2019-11-20T22:29:14Z

Background

← Older revision		Revision as of 22:29, 20 November 2019
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	*Symptoms result from accumulation of plasma cells and paraproteins		*Symptoms result from accumulation of plasma cells and paraproteins
	*Most common primary bone malignancy		*Most common primary bone malignancy
			*More commonly seen in African Americans and males

	==Clinical Features==		==Clinical Features==

2019-11-20T22:28:21Z

Background

← Older revision		Revision as of 22:28, 20 November 2019
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	==Background==		==Background==
	*Malignant proliferation of plasma cells overproduction of abnormal antibodies (paraproteins or light-chain protein)		*Malignant proliferation of plasma cells overproduction of abnormal antibodies (paraproteins or light-chain protein)
			**Osteoclasts are activated through the RANK pathway by the abnormal antibodies leading to osteolytic lesions
	*Symptoms result from accumulation of plasma cells and paraproteins		*Symptoms result from accumulation of plasma cells and paraproteins
	*Most common primary bone malignancy		*Most common primary bone malignancy