* Malignant disorder of plasma cells
* Peak incidence between 60-70 years
* Rare under the age of 30
* Males are affected more than females.

Pathogenesis:

-The tissues are infiltrated by proliferating cells.
-One type of abnormal immunoglobulins (paraprotein) usually IgG or IgA.
-This paraprotein may cause auto-immune manifestations.
-The paraprotein may coat the platelets and coagulation factors.
-Production of incomplete immunoglobulins (light chain only) by plas. cells which are excreted in urine (Bence-Jones protein).
-Diminished production of normal immunoglobulins increases infections.

Clinical picture:

i- Skeletal:

1. Bone aches and pathological fractures
2. Multiple osteolytic lesions in the skull and osteoclast stimulation

ii- Neurological:

1. Compression of spinal cord by vertebral lesion
2. Infiltration of roots, nerves and muscles by plasma cells.

iii- Renal Failure: due to:

1. Bence-Jones proteins: precipitated in kidneys
2. Nephrocalcinosis: caused by hypercalcaemia
3. Hyperuricaemia: due to destruction of plasma cells
4. Amyloidosis of kidneys
5. Pyelonephritis: due to susceptibility to infections

iv- Anemia: due to:

1. BM (bone marrow) replacement by plasma cells
2. BM inhibition by chemotherapy and radiotherapy
3. Haemolysis caused by paraprotein
4. Renal impairment

v- Bleeding Tendency due to:

1. Coating of coagulation factors by paraprotein
2. Coating of platelets by paraprotein

vi- Cardio-Vascular

1. Raynoud’s phenomenon due to cold antibodies
2. Hyperviscosity syndrome

vii- Others:

1. Repeated infections
2. Amyloidosis

Investigations:

1- Blood picture:

* Anemia
* Increased ESR

2- BM Examination:

Full of plasma cells

3- Biochemical:

* Increased calcium in blood
* Increased uric acid in blood
* Alkaline phosphatase: normal

4- Immuno electrophoresis:

Shows marked increase in one type of immunoglobulins

5- Renal:

* Bence-Jones proteins
* Urine electrophoresis: for paraprotein and light chains
* Kidney function tests: may be impaired

6- X-ray:

Multiple osteolytic lesions in bones especially in vertebrae, skull and pelvis.

Treatment:
1- Chemotherapy:
Melphalan or cyclophosphamide.
2- Radiotherapy:
To control tumour masses.
3- Symptomatic:
e.g. infection, renal failure and pain.

Brought to you by Sayed EL Assal who is a physician graduated from faculty of medicine 7 years ago and since then he’s working in health field.

Sayed EL Assal

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