Paraproteinemia
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  • 1. Paraproteinemia John Matthews
  • 2. Definition of a paraprotein
    • A monoclonal immunoglobulin or immunoglobulin light chain in the blood or urine resulting from a clonal proliferation of plasma cells or B-lymphocytes (synonyms: M-band, monoclonal band, monoclonal spike, monoclonal protein)
  • 3. Identification of paraproteins
    • Serum protein electrophoresis
    • Immunofixation
    • Urine protein electrophoresis
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  • 9. Three major disorders associated with paraproteinemia
    • Monoclonal Gammopathy of Undetermined Significance (MGUS)
    • Multiple Myeloma
    • Waldenströms Macroglobulinemia
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    • Incidence
      • 3-6/100,000
      • mean age 60: M=F: Black:White 2:1
    • Cause
      • Unknown (?radiation)
    • Presentation
      • Bone pain 60% Anemia 15% Renal 10% Chance 10% Other 5%.
    • Diagnosis
      • 2 of (a) paraprotein (b) bone lesions (c) plasma cells in BM
    Multiple Myeloma
  • 16. Multiple Myeloma - therapy
    • Attack the neoplasm (chemo  ASCT)
    • Preserve the bones (bisphosphonate)
    • Treat problems: (bones, anemia, infection, renal failure, bleeding, hyperviscosity)
    • Prognosis: incurable: overall median survival 30 months
  • 17. Multiple Myeloma and the Kidney
    • Obstruction of tubules by light chains
    • Tubule-cell damage by light chain
    • Light chain deposition
    • Amyloidosis
    • Hypercalcemia
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