Multiple Myeloma and Related Serum Protein Disorders - Essay Example

? Multiple Myeloma Appraise the results and identify the diagnosis. An old woman of 57 years of age presenting with a history of increasing back pain, fatigue, weight loss and on physical examination, presents with pallor. On doing laboratory tests, the following were found to be positive findings: Red blood cells, haemoglobin concentration and Haematocrit were lower than the normal ranges. Platelet counts were slightly above the normal. On conducting WBC differential count, only monocytes level was found to be elevated. On microscopic examination of her blood, they found the film to be normocytic normochromic with some occasional hypochromic cells. In addition, moderate rouleaux reaction could be noted. A bone marrow aspirate contained plasma cells showing various morphology. A bone marrow trephine test found hyper cellular regions containing clusters of plasma cells. On conducting Serum protein electrophoresis, gamma globulins level was markedly elevated compared to the rest which were at their normal ranges. Presence of markedly high levels of monoclonal protein was also found on her blood biochemistry. IgA and IGM levels were markedly decreased while IGG levels were markedly elevated. On radiological examination of the skull, pelvis, femur and pelvis, multiple lesion were observed. Based on the above symptoms and laboratory findings, the most likely diagnosis is multiple myeloma (Mkolwe, 2011, p. 56) due to presence of plasma cells level above normal in bone marrow aspirate or trephine biopsy, existence of M protein in blood more than 3g/dl and evidence of body damage as seen from presence of destructive bone lesions and anaemia. Explain with reference to the clinical and laboratory data the pathophysiology of the disease Multiple myeloma is a blood cancer affecting plasma cells in the bone marrow (Mkolwe, 2011, p. 56). It mostly involves myeloma cells in the bone marrow. In this condition, we have abnormal production of plasma cells in the bone marrow resulting into complications. A mature normal plasma cell is involved in production of antibodies. In multiple myeloma, there is production of high number of defective plasma cells that do not have the capacity to produce enough antibodies. Antibodies are useful natural mechanism used by the help to help in fighting infections. In collaborating between clinical and laboratory results, one can explain the cause through examining the pathophysiology of multiple myeloma. Anaemia In multiple myeloma, patients often present with features of anaemia like fatigue, pallor, and on laboratory examination, show features of reduced RBC concentration, Haemoglobin concentration because multiple myeloma often results to anaemia of chronic disorders. Production of Myeloma cells in the bone marrow often depresses erythrocyte formation through by down regulating their signalling plus interfering with erythropoietin production by damaging the kidney. Erythropoietin is an important hormone responsible for erythropoiesis process in the human body. Fatigue results due to decrease in oxygen carrying capacity by the RBC due to replacement by the cancerous myeloma in the bone marrow. Anaemia in multiple myeloma is often normocytic normochromic since it is as a result of a chronic condition. White Blood cells Multiple is a B-cell disorder. The body has white blood cells responsible for fighting against infections. B-cells provide humoral immunity through production of antibodies which attach to certain antigens to form immune complexes that then become eliminated in the body via other systems like the complement system. Antibodies commonly produced by B-cells are IgA, IgG, IGM, IgD and IGE. Individuals with multiple myeloma hence have defective production of these antibodies when infected hence making them prone to recurrent infections. From the laboratory results, IGA and IGM levels of the old woman were markedly below the normal expected. As multiple myeloma continues, plasma cell levels increase, but other WBCs level reduces. Therefore, a typical multiple myeloma often present with decreased WBC count. Bone pain/ back pain Increasing back pain is a common manifestation in multiple myeloma. Pain results due to bone marrow replacement, vertebral compression fractures, spinal cord compression or discreet lytic bone lesions (Multiple Myeloma, 2013). Cancerous plasma cells often multiple to an extent of becoming densely concentrated in the bone marrow resulting in pressure build up in them (Chayan, 2011, p. 22). In addition, fractures are common in such bones since they are made brittle by the cancer since the plasma cells always result to lytic lesions. In addition, in the vertebrae, fractures might result to spinal cord compression resulting to back pain (Chayan, 2011, p. 23). A routing x-ray for such patients is a diagnostic tool in noting affected bones as lytic lesions get discovered (Moehler, 2011, p. 67). The lytic lesions in multiple myeloma are characteristically punched out and rounded and commonly exist in the skull, humerus, ribs, femur and ribs (Chayan, 2011, p. 23). Peripheral blood film Peripheral blood film examination in multiple myeloma always exhibit features of normocytic normochromic red blood cell. Rouleaux formation can also be visible in multiple myeloma due to increased erythrocyte sedimentation rate (Multiple Myeloma, 2013). Sometimes, myeloma cells might escape in bone marrow and find their way in the blood. Sometimes, some hypochromic red blood cells might be identified in the peripheral blood film (Moehler, 2011, p. 67). Bone marrow biopsy In carrying out a bone marrow biopsy, in multiple myeloma, the plasma cell concentration in bone marrow is more than 10 % (Wierknik, 2013, p. 34). It characteristically shows clusters of plasma cells. In addition, it appears hyper cellular with marked concentration of myeloma cells (Wierknik, 2013, p. 34). Bone marrow trephine In a bone marrow trephine, one can observe the morphological appearance of plasma cells and see their variability. Serum Protein electrophoresis In doing a normal serum electrophoresis, the results are expected to be like the one below. Albumin levels are supposed to be higher than the alpha, beta and gamma globulin levels (Neil, 2011, p. 66). In multiple myeloma, an abnormal serum electrophoresis of often produced. Gamma globulin levels exhibit a spike. These are the M-protein part of the electrophoresis that is diagnostic of multiple myeloma (Neil, 2011, p. 66). In multiple myeloma, on conducting a serum protein investigation, myeloma (M) proteins are often present (Mkolwe, 2011, p. 57). A normal serum protein electrophoresis should not have any myeloma protein in it as seen from the diagram below. M-proteins levels are often detected in serum or urine. Presence of M-protein in urine might indicate kidney damage (Stephen, 2011, p. 35). 3. Identify possible treatment modalities for this patient and others like her. It is important to know that there is no permanent cure for multiple myeloma. All treatment modalities aim at decreasing its progress and return the body to near body function. The following are hence the treatment modalities employed in treatment of multiple myeloma patients (Mkolwe, 2011, p. 58). The standard treatment regimen entails a combination of the following drugs. This entail giving Melphalan, glucocorticoids and cyclophosphamide as it is the most effective drugs in treating multiple myeloma. Others can be given Melphalan and prednisone (Mkolwe, 2011, p. 58). Other drugs that were used in treatment of multiple myeloma include Bortezomib. This is proteasome inhibitor that is given intravenously to cause cancer cell death. It is mostly used for newly diagnosed patients and those previously on treatment (Mkolwe, 2011, p. 59). Another drug used in multiple myeloma treatment is thalidomide. This is often given orally and has been approved for use in newly diagnosed patients (Mkolwe, 2011, p. 57). Lenalidomide chemically resembles thalidomide though has fewer side effects and more potent. It can be used in newly diagnosed patients or previously treated patients with multiple myeloma (Moehler, 2011, p. 68). Chemotherapy therapy use in multiple myeloma is a common treatment modality. Common chemotherapy drugs use here are Melphalan, vincristine, cyclophosphamide, doxorubicin and liposomal doxorubicin (Moehler, 2011, p. 68). Corticosteroids are often used in relieving the chronic pain and in chronic inflammation cause by the disease. Common corticosteroids used include prednisone and dexamethasone (Moehler, 2011, p. 68). Stem cell transplantation is also treatment modality in multiple myeloma. These stem cells are used in an aim to restore erythropoetic function of red blood cells to relieve the patient of the anaemia (Moehler, 2011, p. 68). Supportive treatment options can be included as part of management of the patient: For instance, management of anaemia through giving blood transfusions or erythropoietin blood builders (Moehler, 2011, p. 69). Giving prophylaxis antibiotics to prevent occurrence of infections. Proper nutrition is also important to such patients. Psychological interventions can also be included as part of the general therapy for such a cancer patient. Bibliography Multiple Myeloma, 2013, January 4. Retrieved February 5, 2013, from Cancer.org: http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-diagnosis Chayan Crouch, 2011, Multiple myeloma presenting as spinal cord compression: a case report, Journal of medica case reports, vol. 34, no 2, pp. 22-26. Mkolwe, A, 2011, Multiple Myeloma, The New England Journal of Medicine, Vol. 23, no. 7, pp. 56-59. Moehler, T., 2011, Multiple Myeloma, Recent Results in Cancer Research, Vol 183, no. 4, pp. 67-70. Neil S. Harris, W. E., 2011, Multiple Myeloma and Related Serum Protein Disorders: An Electrophoretic Guide, New York: Demos Medical Publishing. Schubert, F., 2010, December 10, Protein Electrophoresis and Multiple Myeloma. Retrieved February 5, 2013, from Livestrong.com: http://www.livestrong.com/article/337256-protein-electrophoresis-and-multiple-myeloma/ (Schubert, 2010) Stephen Korbet, M. S., 2011, Multiple Myeloma, Journal of American Society of Nephrology, Vol. 34, no 6, pp. 34-37. Timothy Horita, B. K., 2009, Understanding and Interpreting Serum Protein Electrophoresis, American Family Physician, Vo.l 89, no. 6, pp. 45-48. (Timothy, 2009, p. 46) Wiernik, P. H., 2013, Neoplastic Diseases of the Blood, New York: Springer. Yuan Yuan, R. W., 2012, Multiple Myeloma Involving Skin and Pulmonary Parenchyma after Autologous Stem Cell Transplantation, Journal of Hematology and oncology, Vol. 45, no. 4, pp. 45-49. (Yuan, 2012, p. 46) Read More