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MGUS (interpreting the test you didnt order) Family Medicine Review Course 2011 Christian Cable, MD, FACP
What is the laboratory abnormality? 10-3 = 7 Whats in there?
What comprises the blood?
Whats in blood... Cellular (bone marrow) – RBCs – Platelets – WBCs Plasma (liver) – Water – Proteins Albumin Antibodies Clotting factors
Proteins in the Blood?
Brainstorm As many globins as you can think of...
Tell me more about antibodies
What is the correct test?
SPEP/SIEP SPEP qualitative (is it there?) SIEP quantitative (how much, which one?)
Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Lazarchick, J. ASH Image Bank 2001;2001: Figure 8. Immunofixation electrophoresis showing a monoclonal IgA lambda light chain restricted band
Greek to me (I)... Gamma - - region in electrophoretic mobility Pathy - - disease or condition
Greek to me (II)... Clonal - - type Mono - - one Poly - - many (much)
Differentiate Polyclonal from Monoclonal
What is normal?
Polyclonal gammopathy - -significance Think of an elevated ESR What could cause that?
Is polyclonal gammopathy a plasma cell disorder?
Monoclonal gammopathy - - determined significance
New Myeloma Classification
Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2002;2002: Figure 2. This is a bone marrow aspirate from a patient with multiple myeloma showing the abnormal accumulation of malignant plasma cells
Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Lazarchick, J. ASH Image Bank 2001;2001: Figure 11. Skull x-ray showing multiple lytic areas
Monoclonal gammopathy - - undetermined significance
3% of population over 50 twice that prevalence African Americans
Defined M-spike < 3 g/dL absence of CRAB symptoms (at least those attributable to MM) - - tricky with pre-existing renal disease! Bone Marrow involvement <10% with clonal plasma cells
How to evaluate CBC, Creatinine, Calcium, SPEP/SIEP Skeletal survey (plain films)
When to refer
Higher risk non-Ig G (IgA & Ig M) African American total M spike: >1.5 g/dL
Why follow? Over 20 years: 1% per year turn into either Multiple Myeloma or another blood cancer Double that risk for non-IgG subtypes and African American patients
How do you follow it? Id like to help follow higher risk patients. Lower risk: – re-test in 6 months then annually
SIEP 1.6 g/dL IgA kappa
Recommendations referral bone marrow biopsy
Hematopathology Laboratory Dr. Gilberts lab. CASE 1 Explanation: –Review this case before looking at subsequent cases. On low power, note the architecture.
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BLOOD Blood is a Liquid Connective Tissue that constitutes the transport medium of the circulatory system. The Two main functions of blood are to transport.
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Unit G: Hematology Explain the structure of the blood. Analyze the function of the blood. Discuss characteristics and treatments of common blood disorders.
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The. of and a to in is you that it he for.
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Chronic kidney disease Implementing NICE guidance Second edition 2011 NICE clinical guideline 73.
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Information collected by S.R.BALAJI What Is Hypertension ? Hypertension, or high blood pressure, is a common condition that will catch up with.
High Frequency Words List A Group 1. the of and.
WBC Morphology and Cases Dr. Gilberts Lab. OBJECTIVES: Learn how to identify the types of white blood cells normally present in a differential count.
Mental Illness Part IV. Synesthesia From the Greek words syn (together) and aisthesis (perception) = "joined perception" From the Greek words syn (together)
This short questionnaire will help to determine whether there may be a gene in your family connected to an increased risk of the development of bowel.
Hepatitis B Steve Hart Electron micrograph of serum containing hepatitis B virus after negative staining.
Higher Human Biology Human Cell Types. Introduction The human body is made up of many specialised cells that perform specific functions. Specialised cells.
THECLINICAL SPECTRUM OF CHRONIC PAIN SYNDROMES AFTER TBI Olli Tenovuo MD, PhD Department of Neurology University of Turku, Finland.
What Is Cholesterol? We may associate cholesterol with fatty foods, but most of the waxy substance is made by our own bodies. The liver produces 75% of.
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HPV 101. What is HPV? HPV stands for human papillomavirus. There are more than 100 types of HPV. HPV is so common that three out of four people will have.
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