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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;2001:100185 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;2002:100514 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;2001:100185 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
Understanding Your Blood Work
Plasma cell disorders Dr. hassanali vahedian ardakani Medical oncologist hematologist 2013.
Long-Term Biological Variation of Serum Protein Electrophoresis M-Spike, Urine M-Spike, and Monoclonal Serum Free Light Chain Quantification: Implications.
Plasma cell Disorders S. Sami Kartı, MD, Prof.. Plasma cells Terminally differentiated cells of B- lymphocyte lineage Produce antibodies Normal.
Diagnosis of Paraprotein Diseases CLS 404 Immunology Protein Abnormalities.
PLASMA CELL DYSCRASIAS Monoclonal gammopathy of uncertain significance (MGUS) Idiopathic Associated with other diseases (autoimmune, infectious, non-heme.
Tabuk University 1 3 rd Year – Level 5 – AY Faculty of Applied Medical Sciences Department Of Medical Lab. Technology.
Multiple Myeloma Definition:
Jesse C James MD AM Report May 7, Proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein Malignant.
1.Defining Plasma cell disorders/Multiple Myeloma 2.Identification of different plasma cell disorders. 3.Diagnosis and workup for plasma cell disorders/Multiple.
Clinical interpretation of Serum Free Light Chain assays 22 Feb 2013 Dr. Eric Chan Consultant Immunologist Queen Mary Hospital Hong Kong.
Objectives To introduce the terminology used in describing the plasma cells neoplasm. To explain the physiology of the normal cells & the pathological.
Plasma cell dyscrasias. Multiple Myeloma By Dr. Muna A. Kashmool.
Serum protein electrophoresis is an easy method of separating serum proteins based on their net charge, size, and shape. A small amount of serum is.
Multiple Myeloma Definition: B-cell malignancy characterised by abnormal proliferation of plasma cells able to produce a monoclonal immunoglobulin (M protein)
Multiple Myeloma Morning Report July 21, 2009 Lindsay Kruska.
Director of Scientific Affairs
Staff Oncologist, Mayo Clinic Arizona
CLS 404 Immunology Protein Abnormalities
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