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Paraproteinemia

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Paraproteinemia

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

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