تويت
Multiple myeloma is a disease resulting from infiltration of the bone marrow by neoplastic plasma cells known as myeloma cells.
Common clinical features are bone pain, pathological fractures, anaemia and renal failure. Hypercalcaemia can lead to thirst and dehydration. Hyperviscosity, consequent on the presence of a paraprotein, can cause retinal changes, cardiac failure, drowsiness and even coma.
Myeloma cells are sufficiently similar to normal plasma cells that in the majority of cases they secrete an immunoglobulin, usually either IgG or IgA.
There may also be secretion of light chains of immunoglobulin, either alone or together with a complete immunoglobulin. Since the myeloma cells belong to a single neoplastic clone they express either k or l light chains but not both.
Multiple myeloma in which there is secretion of light chain only is referred to as Bence-Jones myeloma. In rare cases of multiple myeloma there is no immunoglobulin or light chain secreted. Such cases are referred to as non-secretory myeloma.
The common haematological features of multiple myeloma are:
• anaemia (normochromic and either normocytic or macrocytic)
• increased background staining of the blood film as a consequence of increased plasma proteins
• presence of occasional circulating plasma cells
• increased erythrocyte sedimentation rate
Common biochemical abnormalities in multiple myeloma are
• presence of a monoclonal immunoglobulin in the serum
• reduction of concentration of normal immunoglobulins
• presence of a monoclonal light chain (Bence-Jones protein) in the urine
hypercalcaemia
elevated blood urea, creatinine and uric acid
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