11826864 multiple myeloma with pathophysiology

8/18/2019 11826864 Multiple Myeloma With Pathophysiology

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Prepared by:

Maribec V. Pagaduan


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A 69 year old male complained of pain

in his lower back upon bending over inhis garage.

He worked in a petroleum plant for 15

years.He also complained of easy fatigability.


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A radiograph of the spine shows acompression fracture of the lumbar

vertebrae at L2 – L3.

Further evaluation revealsnormocytic anemia, hypercalcemia,

and a high globulin fraction. Bone

marrow biopsy was also done.


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Other name: Plasma cell myeloma

Second most common hematologic

malignancy.

It affects osseous and non-osseous

tissues.


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The cause of myeloma is unknown

High occurrence among the following:

- Those exposed to radiationwarheads

- Myeloma has been seen more

commonly than expected among farmers,

wood workers, leather workers, and those

exposed to petroleum products.


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Occurrence: 2-4/100,000

Age: Increases with age

Median Age of Px: 65 y/o

Gender: More men than women

Race: More common in Blacks than inCaucasians, Asians – low incidence.


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RED

BONEMARROW

Composition

1.The PARENCHYME

2.The STROMA


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- Continuous

rep!"ement o#

o$ %one tissue

%& ne' %one

tissue

2 t&pes o# "es

1.Osteo%!sts2.Osteo"!sts


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Used to determinesize and shape of

RBCs, WBCs and

platelet precursorsand to examine

various

maturationalabnormalities.

Gold standard for

diagnosing MM


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(2-()

Compression

Non destructive

method of inspection

Each specimen under

evaluation will havedifferences in density,

thickness, shapes,

sizes, or absorption

characteristics


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R!n$om& $istri%ute$* roun$e$* pun"he$ out &ti"

esions throu+hout the s,u.


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P!tient Norm!

WBC ). 1/)0u( ).)-11./

Neut 3 4 -55

(&mph 264 12-)

Mono 4 2-11

Eos /4 /-7

B!so /4 /-2

RBC 3.2 X 106 /uL ).3-7./

Reti"uo"&tes 1.4 /.7-1.7

Hgb 8.6 g/dL 11.8-17.8

HCT 26.1 % )6.2-7/.

MC9 51.7 #( 63-33./

MCH 28.5 p+ 28./-)2.8

MCHC )2.3 +0$( )1./-)8./

Plts 110 thousands/uL 1)/-//


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Test P!tient Norm!

:u"ose 3/ m+0$( 87-11/

Creatnne 1.! "g/dL /.6-1.

B#$ 2! "g/dL 6-2

#r &d ! "g/dL )./-5.7

Choestero 133 m+0$( 17/-2/

Calu" 12 "g/dL 5.7-1/.7

Proten 10.! g/dL 8-5

A%umin ).6 +0$( ).6-7./

L'H 2(0 #/L 1//-227

&l). Phos. 210 #/L )/-12/

AST 7/ ;0( /-77

::TP )7 ;0( /-7/

Biiru%in0Bi. Dire"t /.6 m+0$(0.11 m+0$( /./-1.70./2-15


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Test

P!tient Norm!

pH 8 7./-6.7

Proten 3* Ne+

:u"ose Ne+ Ne+

/-7

RBC 10HP> /-2


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A process of separatingelectrically

charged particles in solution bypassing an electric current

through the solution

Particularly used to

determinewhether the humoralimmunity

function normally or not.


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Albumin α1 α2 β γ


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MAJOR CRITERIA

I.Plasmacytoma by biopsy

II.>30% marrow plasmacytosis

III.Monoclonal gammopathy

Serum: IgG > 3.5 g/dL, IgA >2 g/dL

Urine: >1 g/d of Bence Jones ProteinsMINOR CRITERIA

A.10-30% marrow plasmacytosis

B.Monoclonal gammopathies with lower values

than above

C.Lytic bone lesions

D.Suppressed normal immunoglobulins


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Durie-Salmon Staging SystemStage Criteria Estimated Tumor

Burden, x 1012 cells/m2

I All of the following:

1.Hemoglobin >100 g/L (>10 g/dL)

2. Serum calcium


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Age: 69 y/o, Male, Hx of working in a petroleum plant

DNA is damaged during the development of stem cell into a B – cell

Development of malignant plasmablasts

Produce adhesive molecules and bind to Bone Marrow Stromal Cells

Malignant plasmablast grows into malignant plasma cells

Uncontrolled proliferation of malignant plasma cell clones

Formation of

Plasmacytomas

Production of

Paraproteins

(M-protein)

Production of

Bence Jones

Protein

Formationof


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Formation of

Plasmacytomas

Compression of

surrounding bonetissue, bone marrow

and nerve endings

PAIN

↓ Hematopoesis

Release of IL-6 and TNF

Recruitment and

activation of osteoclasts

Osteoclasts attach to

bone tissue

Protein digesting enzyme Acids

Digestion of collagen and fibers Dissolves bone minerals

PUNCHED-OUT

OSTEOLYTIC LESIONS

Continuous bone destruction

PATHOLOGIC

FRACTURE

Calcium is released

and enters thebloodstream

HYPERCALCEMIA

Destruction of

Bone marrow

stem cells

↓osteoblasts

↓bonedeposition


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?Hem!topoiesis

?RBC

ANEM@A

?Me+!,!r&o"&tes

?P!teets

Sus"epti%iit& to%ee$in+

?WBC

Sus"epti%iit& toin#e"tion

E!s& #!ti+!%iit&

THROMBOCYTOPEN@A

(eu,openi!


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Formation of

Plasmacytomas

Production of

Paraproteins

(M-protein)

Production of

Bence Jones

Protein


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Production of

Paraproteins

(M-protein)

↑ Serum Monoclonal Antibodies

Normal Plasma cellbreakdown

↓ Normal Antibody

productionHYPERVISCOSITY

SYNDROME

Binds with other serum

protein

Disrupted antibody

mediated immunity

Sus"epti%iit& to

in#e"tion

↑ Susceptibility to

bleeding


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Formation of

Plasmacytomas

Production of

Paraproteins

(M-protein)

Production of

Bence Jones

Protein


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Production of Bence

Jones Protein

Blockage of tiny kidney

tubules

Excreted in

urine

↓erythropoietin

PROTEINURIA

↓ elimination of

nitrogenous

waste

UREMIA

ANEMIA

↓RBC

Production

Glomeruli filters largeamounts of Bence-

Jones Protein

Proteinaceousinclusion bodies

accumulates in

the tubules

Cellular degeneration and

impairment of kidney/tubular

function


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Chronic Pain Activity intoleranceRisk for Infection

Fear/Anxiety


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Trials of Arsenic Trioxide in Multiple Myeloma

Mohamad A. Hussein, MD


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Anatomy and Physiology by Tortora, 11th ed.

Clinical Physiology by Moran Campbell

Pathophysiology By Porth, 4th ed.

Harrison’s Principles of Internal Medicine, 17th ed.

Wintrobe’s Clinical Hematology,

Blood and Bone Marrow Pathology by Wickramasinghe

and McCullough

11826864 multiple myeloma with pathophysiology

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