TAILIEUCHUNG - Chapter 106. Plasma Cell Disorders (Part 6)

The clinical evaluation of patients with myeloma includes a careful physical examination searching for tender bones and masses. Only a small minority of patients has an enlargement of the spleen and lymph nodes, the physiologic sites of antibody production. Chest and bone radiographs may reveal lytic lesions or diffuse osteopenia. MRI offers a sensitive means to document extent of bone marrow infiltration and cord or root compression in patients with pain syndromes. A complete blood count with differential may reveal anemia. Erythrocyte sedimentation rate is elevated. Rare patients (~2%) may have plasma cell leukemia with 2000 plasma cells/µL. This. | Chapter 106. Plasma Cell Disorders Part 6 The clinical evaluation of patients with myeloma includes a careful physical examination searching for tender bones and masses. Only a small minority of patients has an enlargement of the spleen and lymph nodes the physiologic sites of antibody production. Chest and bone radiographs may reveal lytic lesions or diffuse osteopenia. MRI offers a sensitive means to document extent of bone marrow infiltration and cord or root compression in patients with pain syndromes. A complete blood count with differential may reveal anemia. Erythrocyte sedimentation rate is elevated. Rare patients 2 may have plasma cell leukemia with 2000 plasma cells pL. This may be seen in disproportionate frequency in IgD 12 and IgE 25 myelomas. Serum calcium urea nitrogen creatinine and uric acid levels may be elevated. Protein electrophoresis and measurement of serum immunoglobulins and free light chains are useful for detecting and characterizing M spikes supplemented by immunoelectrophoresis which is especially sensitive for identifying low concentrations of M components not detectable by protein electrophoresis. A 24-h urine specimen is necessary to quantitate protein excretion and a concentrated aliquot is used for electrophoresis and immunologic typing of any M component. Serum alkaline phosphatase is usually normal even with extensive bone involvement because of the absence of osteoblastic activity. It is also important to quantitate serum 02-microglobulin see below . Serum soluble IL-6 receptor levels and C-reactive protein may reflect physiologic IL-6 levels in the patient. The serum M component will be IgG in 53 of patients IgA in 25 and IgD in 1 20 of patients will have only light chains in serum and urine. Dipsticks for detecting proteinuria are not reliable at identifying light chains and the heat test for detecting Bence Jones protein is falsely negative in 50 of patients with light chain myeloma. Fewer than 1 of patients have no .

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