What You Need to Know About Multiple Myeloma and How to Diagnose It

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Some facts about this disease:

• Malignant disorder of plasma cells
• Peak incidence between 60-70 years
• Rare under the age of 30
• Males are affected more than females.

Pathogenesis:
-The tissues are infiltrated by proliferating cells.
-One type of abnormal immunoglobulins (paraprotein) usually IgG or IgA.
-This paraprotein may cause auto-immune manifestations.
-The paraprotein may coat the platelets and coagulation factors.
-Production of incomplete immunoglobulins (light chain only) by plas. cells which are excreted in urine (Bence-Jones protein).
-Diminished production of normal immunoglobulins increases infections.
Clinical picture:
i- Skeletal:

1. Bone aches and pathological fractures
2. Multiple osteolytic lesions in the skull and osteoclast stimulation

ii- Neurological:

1. Compression of spinal cord by vertebral lesion
2. Infiltration of roots, nerves and muscles by plasma cells.

iii- Renal Failure: due to:

1. Bence-Jones proteins: precipitated in kidneys
2. Nephrocalcinosis: caused by hypercalcaemia
3. Hyperuricaemia: due to destruction of plasma cells
4. Amyloidosis of kidneys
5. Pyelonephritis: due to susceptibility to infections

iv- Anemia: due to:

1. BM (bone marrow) replacement by plasma cells
2. BM inhibition by chemotherapy and radiotherapy
3. Haemolysis caused by paraprotein
4. Renal impairment

v- Bleeding Tendency due to:

1. Coating of coagulation factors by paraprotein
2. Coating of platelets by paraprotein

vi- Cardio-Vascular

1. Raynoud's phenomenon due to cold antibodies
2. Hyperviscosity syndrome

vii- Others:

1. Repeated infections
2. Amyloidosis

Investigations:
1- Blood picture:

• Anemia
• Increased ESR

2- BM Examination:
Full of plasma cells
3- Biochemical:

• Increased calcium in blood
• Increased uric acid in blood
• Alkaline phosphatase: normal

4- Immuno electrophoresis:
Shows marked increase in one type of immunoglobulins
5- Renal:

• Bence-Jones proteins
• Urine electrophoresis: for paraprotein and light chains
• Kidney function tests: may be impaired

6- X-ray:
Multiple osteolytic lesions in bones especially in vertebrae, skull and pelvis.
Treatment:
1- Chemotherapy:
Melphalan or cyclophosphamide.
2- Radiotherapy:
To control tumour masses.
3- Symptomatic:
e.g. infection, renal failure and pain.

Brought to you by Sayed EL Assal who is a physician graduated from faculty of medicine 7 years ago and since then he's working in health field.

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