Myeloma Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Myeloma and links to relevant pages within the course.
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| Clinical Significance cont'd Proteinuria related to kidney impairment may be due to glomerular membrane damage caused by toxic agents, immune complexes found in lupus erythematosus, or streptococcal glomerulonephritis. The amount of protein present in urine samples from patients with glomerular damage usually ranges from 10-40 mg/dl. If the urinary protein is due to a disorder that affects tubular reabsorption, the urine protein quantities will be much greater. In patients with multiple myeloma, proteinuria is due to the excretion of the Bence Jones protein. This low molecular weight protein produced by a malignant clone of plasma cells circulates in the blood and is filtered in the kidneys in quantities exceeding the tubular capacity. This excess protein is excreted in the urine. | View Page |
| Examples of conditions resulting in benign proteinuria include: (Choose ALL of the correct answers) | View Page |
| Which of the following conditions produce glycosuria? (Choose ALL of the correct answers) | View Page |
| Which of the following conditions will not produce a characteristic protein electrophoresis pattern: | View Page |
| This SPE scan most likely represents which of the following disease states: | View Page |
| Bence-Jones proteinuria can be seen in all of the following conditions except: | View Page |
| Bence-Jones proteinuria is associated with all of the following conditions except: | View Page |
| Which one of the following terms does not describe a significant elevation of a single immunoglobulin class: | View Page |
| What is the cell indicated by the arrow in this illustration: | View Page |
| Diseases Associated with Proteinuria Severe proteinuria (greater than 3.5 g/day) is characteristically seen in patients with glomerulonephritis, lupus nephritis, lipoid nephrosis, and severe venous congestion of the kidney. Moderate proteinuria (0.5-3.5g/day) is seen in nephrosclerosis, multiple myeloma, diabetes nephropathy, malignant hypertension, and pyelonephritis with hypertension. Mild proteinuria (less than 0.5 g/day) may be seen with polycystic kidneys, chronic pyelonephritis, benign orthostatic proteinuria, and some renal tubular diseases. Transient proteinuria can also be due to physiologic conditions such as stress, exercise, cold exposure, and fever, in the absence of renal disease. | View Page |
| Heat and Acid Test for Urinary Protein The heat and acetic acid test is another semiquantitative test used to confirm the presence of protein in urine. It is more sensitive than the SSA test because the pH of the sample is brought close to the isoelectric point of proteins. However, this test is sometimes considered too sensitive because it can detect trace amounts of protein which are considered normal. The heat and acetic acid test gives false positive results with inorganic iodides, benzoin, tolutamide, and proteoses, similar to the SSA test. Bence-Jones protein consists of dimers of either kappa or lambda light chains from immunoglobulins. This abnormal protein is most often associated with multiple myeloma, but can also be found in cases of lymphoma, macroglobulinemia, leukemia, and other malignancies (Balant and Fabre, 1978). Testing for Bence-Jones protein is not part of the routine urinalysis. However, if Bence-Jones protein is suspected, the heat precipitation test or immunoelectrophoresis can be performed on a urine specimen. The heat precipitation test is based on the protein’s unusual solubility properties. Bence-Jones protein precipitates at temperatures between 40ºC and 60ºC (56ºC optimum), but dissolves again at 100ºC. Upon cooling, the precipitate will reappear around 60ºC and will dissolve again below 40ºC | View Page |
| Review 1 Lorimer JW. Eidus LB.:
Invasive Clostridium septicum infection in association with colorectal carcinoma.
Canadian Journal of Surgery. 37:245-9, 1994The association between invasive Clostridium septicum infection and colorectal carcinoma is examined by the presentation of three cases and a review of the literature.In the first two cases the patients presented with nontraumatic metastatic clostridial gas gangrene.In the third case a patient with chemotherapy-induced myelosuppression from concomitant multiple myeloma had a necrotizing transmural infection of the right colon.The apparent portal of entry of Clostridium septicum was an occult carcinoma of the ascending colon. The increasing evidence for a strong link between this organism and some cases of neutropenic enterocolitis is reviewed. | View Page |
| In which of the following conditions are Pappenheimer bodies and siderocytes seen on the peripheral smear? | View Page |
| Disorders in which coarse basophilic stippling can be seen are: (Choose ALL of the correct answers) | View Page |
| Increased Plasma Cells Although an occasional plasma cell is normal in the marrow, the presence of sheets of plasma cells, as seen here, is consistent with multiple myeloma. | View Page |
| Bone marrow examination may be used to aid in the diagnosis of: | View Page |
| The arrangement of the erythrocytes in this peripheral smear should be reported out as rouleaux formation. | View Page |
| True Rouleaux This field shows an example of rouleaux. Notice that most of the red cells seen in the field, in the proper viewing area, are stacked together like coins. Four or more cells make up each formation in this slide, leaving much of the field empty of cells (increased white space).
Rouleaux is clinically significant when increased globulins are present, as in multiple myeloma. | View Page |
| True Rouleaux Another example of rouleaux is seen in this slide taken from a patient with multiple myeloma. Frequently, the darkly stained macroscopic appearance of the slide will be a clue to the presence of rouleaux on the smear. Increased globulins in the plasma oftne cause the background of the stained smear to be somewhat bluer than the other slides stained at the same time. | View Page |
| Match the letter representing the cell type with the condition in which increased numbers of the cell may be found in the peripheral smear. | View Page |
| The globular inclusions in this cell are fat droplets. | View Page |
| The upper photograph of a peripheral blood smear reveals RBC rouleaux formation. Nucleated cells evident in both upper and lower photographs comprise approximately 5% of the total white blood cell count. The most probable underlying condition is: | View Page |
| The cell photographed here is known as a MOTT cell. The condition in which these cells are associated is: | View Page |
| Approximately 10% of the circulating white cells were similar to the one seen in the photograph. The patient was 42 years old and visited his physician because of recent bruising. Note the absence of platelets on the smear. Possible associated conditions include: | View Page |
| Multiple myeloma Plasma cells are uncommonly observed in the peripheral blood smear.They are normal constituents of lymph nodes, spleen, connective tissue and bone marrow. The presence of plasma cells in the peripheral blood is indicative of a large number of conditions mostly related to infections , immune disorders, malignancies, toxic exposures, hypersensitivity reactions and their responses.Although mature plasma cells have a distinct appearance, they still may be confused morphologically with immature plasma cells and other cells with inclusions, reactive changes or nucleated red bloods cell with altered identities.In the upper and lower photographs are plasma cells with features mindful of myeloma cellsThe large myeloma cell in the upper photograph has an eccentric immature nucleus with a muddy chromatin pattern.Note also clumping and stacking of the erythrocytes, bordering on rouleaux formation ,implicating an increase in plasma gamma globulin.The plasma cell with the double nucleus in the lower photograph is particularly suggestive of myeloma.Further studies are in order including a bone marrow examination where at least 30% of bone marrow cells should be variations of mature and immature plasma cells.Serum electrophoresis will reveal a monoclonal globulin spike, and light chains in excess of 1.0 gm/24 hours may be seen in the urine.The presence of lytic bone lesions is a convincing clinical clue.With these findings in combination, a diagnosis of myeloma can be made with assurance. | View Page |