A 67 year old elderly male presents with headache, recurrent infections and multiple punched out lytic lesions of X-ray skull and lumbago for last 1 months.The investigadon that will be help in establishing a diagnosis is –
Correct Answer: Protein electrophoresis
Description: Ans. is 'a' i.e., Protein electrophoresis Clinical features of multiple myeloma:-o Peak age of incidence of multiple myeloma is between 50 and 60 years.o The clinical features stem from the effects of-Infiltration of organs, particularly bones, by the neoplastic plasma cells.The production of excessive immunoglobulin which often have abnormal physiochemical properties.The Suppression of normal humoral immunity.Clinical features areBone pain, pathological fracture, osteoporosis, hypercalcemia because of tumor expansion in bone marrow and secretion of osteolytic cytokines by neoplastic plasma cells.Renal failure because of hypercalcemia, damage by Bence Jones protein, Urate nephropathy, amyloidosis.Recurrent infections because of hypogammoglobulinemia.Pancytopenia because of marrow infiltration by tumor cells that results in anemia, neutropenia and thrombocytopenia.Neurological symptoms because of hyperviscosity and hypercalcemia.Nausea and vomiting because of renal failure and hypercalcemia.Bleeding tendency Platelets get coated by M protein. So, there is impairment in adhesion and aggregation.Coagulation abnormality M proteins interfere with coagidation factors.Amyloidosis - AL type.CryoglobulinemiaDiagnosis o f multiple myelomao Patients suspected of having multiple myeloma (MM) should initially undergo a complete history and physical examination. The history should pay specific attention to complaints of bone pain, constitutional symptoms, neurological symptoms, and infections. The physical examination should include a detailed neurologic exam.The following laboratory studies should be performed as an initial screen to look for MM:o A complete blood count and differential with examination of the peripheral blood smear.o A chemistry screen that includes measurements of serum calcium, creatinine, albumin, lactate dehydroge-nase, beta-2 microglobulin, and C-reactive protein.o Serum free monoclonal light chain (FLC) analysis.o A serum protein electrophoresis (SPEP) with immunofixation and quantitation of immunoglobulins.o A routine urinalysis and a 24-hour urine collection for electrophoresis (UPEP) and immunofixation.Serum free FLC analysis may be used in place of a 24-hour urine collection in conjunction with SPEP and immunofixation for screening purposes only. Howe'er. if a plasma cell proliferative disorder is identified, the UPEP and immunofixation are necessary.o Serum viscosity should be measured if the M-protein concentration is high (ie, >5 g/dL) or there are symp-toms suggestive of hyperviscosity.o Bone marrow aspiration and biopsy with immunophenotyping, conventional cytogenetics, and fluorescence in situ hybridization (FISH).Although a bone marrow evaluation is indicated for all patients with MM at diagnosis, it may be deferred for persons that are clinically suspected of having MG US with a small monoclonal protein (less than 1.5 g/100 mL), minimal or no abnormalities in serum free light chains, and no end organ damage.o A metastatic bone survey with plain radiographs including the humeri and femoral bones should be per-formed in all patients.If patients have a normal bone survey in the setting of bone pain, or have neurological deficits that may be due to spinal cord compression, additional imaging such as MR1, CT, or PET/CT should be perf ormed to ride out myeloma bone disease. MR1 and PET/CT are useful in patients in whom there is uncertainty about the extent of bone disease, and the role of these imaging modalities is evolving.DIAGNOSTIC CRITERIAOFML'LTIPLE MYELOMAMajor criteria1. Plasmacytoma on tissue biopsy2. Bone marrow plasmocytosis > 30% of plasma cells.3. o Monoclonal globulin spike IgG > 35g/l, or IgA > 20g/Lo Light chain excretion on urine electrophoresis > lg/24 hrsMinor criteria1. Bone marrow plasmacytosis, 10-30% plasma cells.2. Monoclonal globulin spike. IgG^Sg'L orlgA < 20g;L3. Lytic bone lesions.4. Normal IgM < 500 mg'L, IgA < 1 g'L or IgG < 6g'LCriteria for multiple myeloma1. major & 1 minor criteriaOR2. minor criteria that must include 1 and 2 of minor criteria.
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