Resident Report 2/10 – Paraproteinemias

Teaching Points:

  • Multiple Myeloma
    • Plasma cell dyscrasia causing monoclonal antibody development complicated with end organ damage
    • Criteria For Diagnosis
      • M-spike (suggest overproduction of a specific antibody)
      • Bone Marrow Biopsy with >10% plasma cells
      • Evidence of end-organ damage (CRAB)
        • Hypercalcemia – 25%
        • Renal insufficiency – 50%
          • Prone to worsening renal disease as a result of diuresis and NSAID therapy
        • Anemia – 75%
        • Bone involvement – 50%
          • Patients present with bony pain worsened with movement.
    • Differential Diagnosis
      • Smoldering Multiple Myeloma
        • M-spike protein >3g/dl
        • Bone marrow biopsy with plasma cells >10%
        • No evidence of end organ damage (CRAB criteria)
      • MGUS
        • M-spike <3g/dL
        • Bone marrow biopsy with plasma cells <10%
        • No evidence of end organ damage (CRAB criteria)
    • Waldenstrom’s macroglobulinemia differs from multiple myeloma in that the monoclonal spike is due specifically to IgM.
      • IgM is a tetramer and instead manifests as hyperviscosity syndrome.
      • Patients may also have lymphadenopathy, splenomegaly, etc.

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