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Pathology
Clonal proliferation of plasma cells.
They usually produce monoclonal immunoglobulins (paraprotein) or part of an immunoglobulin (light chains), promote excess osteoclastic activity
Aetiology
Weak association with radiation, benzene, pesticide and farm working.
Signs
Bleeding, bruising, purpura, pallor, bony tenderness
Symptoms
Often asymptomatic, bone pain caused by lytic lesions & pathological fractures, hypercalcaemia, marrow failure, blurred vision, headaches, hypercalcaemia, renal failure
Investigations
Bloods: FBC, U&E, Calcium, LFTs, ESR, CRP, Serum free light chains
Serum Electrophoresis: Paraproteins
Blood Film: Rouleaux formation – RBCs sticking together
MSU: Bence Jones protein (light chains found in the urine)
Imaging: Skeletal survey – may show punched out lesions in skull
Bone Marrow Aspirate: Plasma cell infiltration
Treatment
Medical: Analgesia, Antibiotics, IV Fluids, Bisphosphonates, Radiotherapy,
Chemotherapy, Allogenic Stem Cell Transplantation, Plasmapheresis
Prognosis
Median survival approximately 5 years
Infection, anaemia, bleeding, hair loss, GI toxicity, organ damage, renal failure, amyloidosis, spinal cord compression, bone fractures
Key Facts
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Key References
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