11/20/2023 0 Comments Multiple myeloma lab findings usmleSecondly, they can have features of immaturity, such as low nuclear-cytoplasmic ratio, larger size, loose chromatin (i.e., a plasmablast). The Golgi apparatus typically produces a light-colored area next to the nucleus, called a perinuclear halo. Firstly, they could take the form of a mature, normal plasma cell (a large cell, two or three times the size of a lymphocyte, with a single eccentric nucleus displaced by an abundant, basophilic cytoplasm). The plasma cells seen in multiple myeloma have several possible morphologies. This percentage is required in the diagnostic criteria for myeloma. HistopathologyĪ bone marrow aspirate and biopsy are usually performed to estimate the percentage of abnormal plasma cells. Several intracellular and intercellular signaling cascades, numerous chemokines, and interleukins are implicated in this complex process. In addition, the interaction between myeloma cells and the bone microenvironment ultimately leads to the activation of osteoclasts and suppression of osteoblasts, resulting in bone loss. one marrow occupation by the expanding plasma cell clone usually manifests as anemia, thrombocytopenia, and leukopenia. Regardless of the molecular driver, once there is excess monoclonal immunoglobulins, hyperviscosity, platelet dysfunction, and renal tubular damage can occur, leading to neurologic derangements, bleeding, and renal failure respectively. Under the "second hit" hypothesis, progression could also be a consequence of additional cytogenetic lesions gained by the original plasma cell clone, caused either by genetic instability or abnormalities in the hematopoietic microenvironment. However, as noted above, genetic alterations may cause an increased expression of promoter genes or resistance to apoptosis, both resulting in higher plasma cell proliferation and population. The exact causes of MGUS development and progression to MM remain unknown. his is typically a benign condition, although as noted above, it has a risk of progression to MM of about 1% per year. It appears that the cell of origin is a post-germinal center plasma cell. This is quite common and is known to be detectable in over 3% of persons above age 50. MGUS is defined as detecting monoclonal immunoglobulins in the blood or urine without evidence of end-organ damage. It is thought to arise from a pre-malignant, asymptomatic phase of clonal plasma cell growth called monoclonal gammopathy of undetermined significance (MGUS). MM is essentially a stage in the spectrum of monoclonal gammopathy. There seems to be an increased incidence in African American and black populations by as much as two-fold compared to Whites. It occurs predominantly in the geriatric population with a median age at diagnosis of about 70 years and is slightly more commonly seen in males than females (1.4:1). Multiple myeloma is relatively uncommon and only represents about 1.8% of all new cancer cases diagnosed in the United States each year. Other factors contributing to disease occurrence include obesity, alcohol consumption, environmental causes such as insecticides, organic solvents, agent orange, and radiation exposure. In addition, other oncogenes such as NRAS, KRAS, and BRAF may participate in plasma cell proliferation. However, frequent alterations and translocations in the promoter genes, especially chromosome 14, are commonly found in multiple myeloma and likely play a role in disease development. The exact etiology of multiple myeloma is unknown. Obviously, the differential is broad with any of these symptoms and/or findings, but it is imperative MM be kept in mind as part of the differential as management is unique and improved outcomes are available with timely intervention is made. Most commonly, this is seen when at least one of the following clinical manifestations are present: hypercalcemia, renal dysfunction, anemia, or bone pain accompanied by lytic lesions. Unchecked, the excess production of these plasma cells can ultimately lead to specific end-organ damage. Multiple myeloma (MM) is a clonal plasma cell proliferative disorder characterized by the abnormal increase of monoclonal immunoglobulins. Outline the adverse effects of the disease process as well as treatment-related side effects.Summarize the first-line therapy options for multiple myeloma.Review the appropriate steps in evaluating a patient suspected of having multiple myeloma. Describe the pathophysiology of multiple myeloma.The importance of early recognition, treatment, and an interprofessional approach is highlighted in this activity. This activity reviews the underlying cause, presentation, diagnosis, and treatment of multiple myeloma. The consequences of undiagnosed disease are severe. Multiple myeloma is a clonal plasma cell proliferative disorder characterized by the abnormal increase of monoclonal paraprotein leading to evidence of specific end-organ damage.
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