blood tumours identification by gamma globulins

1. MULTIPLE MYELOMA
By Lwitiko Mwakagile Amos
Medical Laboratory Scientist
Laboratory QMS Mentor

2. MULTIPLE MYELOMA
Myel- mean BONE MARROW while –Oma mean
TUMOUR
Multiple myeloma (MM), also known as plasma cell
myeloma, is a cancer of plasma cells, a type of white
blood cell that normally produces antibodies.
The cause of multiple myeloma is unknown.
Risk factors include obesity, radiation exposure,
family history, and certain chemicals

3. PATHOPHYSIOLOGY
B lymphocytes start in the bone marrow and move to the lymph
nodes.
As they progress, they mature.
When they are activated to secrete antibodies, they are known as
plasma cells
The immune system keeps the proliferation of B cells and the
secretion of antibodies under tight control.
When chromosomes and genes are damaged, often through
rearrangement, this control is lost.
As a result stimulates abnormal antibodies overproduction

4. NORMAL FORMATION OF BLOOD CELLS
PATHWAYS

5. ABNORMAL FORMATION OF BLOOD CELLS
PATHWAYS

7. CAUSE OF MULTIPLE MYELOMA
The cause of multiple myeloma is
generally unknown
But there is various risk factors that
may lead into development of multiple
myeloma
These risk factors are as follows;

8. 1. Monoclonal gammopathy of undetermined
significance (MGUS)
Is a plasma cell disease in which plasma cells
secrete abnormal antibodies called monoclonal
paraproteins or myeloma proteins or M
Proteins(gammopathy), into the blood.
This abnormal protein is usually found during
standard laboratory blood or urine tests.
MGUS resembles multiple myeloma and
similar diseases

9. Cont….
But the levels of antibodies are lower and the
number of plasma cells in the bone marrow is
also lower.
Rarely has symptoms or major problems
MGUS transforms to multiple myeloma at the
rate of 1% to 2% per year, and almost all cases of
multiple myeloma are preceded by MGUS

10. 2. Smoldering myeloma
Is a disease of plasma cells secreting monoclonal
paraprotein causes the relatively benign disease of
monoclonal gammopathy of undetermined
significance.
This clone proliferates and may slowly evolve into
more aggressive sub-clones that cause smoldering
multiple myeloma.
Further and more rapid evolution causes the
malignant stage of multiple myeloma

11. Cont….
Smoldering myeloma, however, is not a malignant disease.
It is characterized as a pre-malignant disease that lacks
symptoms
Is associated with bone marrow biopsy showing the presence
of an
Abnormal number of clonal myeloma cells
Blood and/or urine containing a myeloma protein
Therefore is a significant risk of developing into a malignant
disease
3. Obesity is related to multiple myeloma with each increase of
body mass index

12. 4. Occupational exposure to aromatic
hydrocarbon solvents
• Evidence has shown that these solvents such as
benzene, toluene and xylene have a role in causation
of multiple myeloma.
• The risk of multiple myeloma occurring is greater in
occupations such as;
Firefighter
Hairdresser
Agricultural
Industrial

13. 5. Epstein–Barr virus (EBV)
Rarely, Epstein–Barr virus (EBV) is associated
with multiple myeloma,
When associated with immunocompromised
individuals due to e.g. HIV/AIDS, organ
transplantation, or a chronic inflammatory
condition such as rheumatoid arthritis there is a
high risk of developing multiple myeloma.

14. SIGNS AND SYMPTOMS
Bone pain, especially in spine or chest
Nausea
Constipation
Loss of appetite
Mental fogginess or confusion
Fatigue
Frequent infections
Weight loss
Weakness or numbness in your legs
Excessive thirst

15. CLINICAL COMPLICATION
1. Bone complications and pain
Bone pain affects almost 70% of people
with multiple myeloma and is one of the
most common symptoms.
Myeloma bone pain usually involves the
spine and ribs, and worsens with activity.

16. 2. Anemia
The anemia found in myeloma is usually
normocytic and normochromic (normal size and
Hb content respectively but abnormal number of
RBC).
It results from the replacement of normal bone
marrow by infiltrating tumor cells and inhibition
of normal red blood cell production.

17. 3. Impaired kidney function
Impaired kidney function may develop, either acutely or chronically,
and with any degree of severity.
The most common cause of kidney failure in multiple myeloma is due
to proteins secreted by the malignant cells.
Myeloma cells produce monoclonal proteins of varying types, most
commonly immunoglobulins (antibodies) and free light chains,
resulting in abnormally high levels of these proteins in the blood.
Depending on the size of these proteins, they may be excreted
through the kidneys.

18. Cont…
Kidneys can be damaged by the effects of proteins or light chains
(interfere with absorption process).
Increased bone resorption leads to hypercalcemia and causes
nephrocalcinosis (calcium deposition in renal parenchyma), thereby
contributing to kidney failure.
Amyloidosis (accumulation of abnormal proteins in renal
parenchyma) is a distant third in the causation.
 People with amyloidosis have high levels of amyloid
protein that can be excreted through the kidneys and
cause damage to the kidneys and other organs

19. 4. Infection
Infections are common with multiple myeloma, since the
disease impairs functioning of blood components that
normally resist pathogens.
The most common infections are pneumonias, urinary
tract infections, and sepsis.
The greatest risk period for the occurrence of infection is
in the initial few months after the start of a new MM drugs
therapy.
Many drug therapies further suppress the normal immune
response

20. 5. Neurological impairment
Spinal cord may be affected leading to loss of bowel
or bladder control
6. Mouth
The initial symptoms may involve pain, numbness,
swelling, expansion of the jaw, tooth mobility.
Multiple myeloma in the mouth can cause common
tooth problem

21. DIAGNOSIS
1. BLOOD TEST
i) Protein electrophoresis of the blood and urine; which might show
the presence of a paraprotein (monoclonal protein, or M protein) band.
There might be a reduction or no change of the other (normal)
immunoglobulins.
One type of paraprotein is the Bence Jones protein, which is a
urinary paraprotein composed of free light chains.
Quantitative measurements of the paraprotein are necessary to
establish a diagnosis and to monitor the disease.

22. NORMAL SERUM AND URINE PROTEIN
ELECTROPHORESIS

23. ABNORMAL SERUM AND URINE PROTEIN ELECTROPHORESIS
WITH ADDITIONAL GAMMA MYELOMA PROTEINS

24. ii) Electrolyte test
Calcium level may be eleveted (when osteoclasts are
breaking down bone, releasing it into the
bloodstream)
iii)Renal function test
Serum creatinine level may elevate due to reduced
kidney function.

25. 2.BONE MARROW BIOPSY
Is usually performed to estimate the percentage
of bone marrow occupied by plasma cells

26. PREVENTION?