Plasma cell Dyscrasia 1- B.M.G. 2- Multiple Myeloma 3- Waldenstrom Macroglubolenemia 4- Heavy Chain disease 5- Amyloidosis

Type of Monoclonal Paraproteins Percentage !gG ………………………… IgA …………………………………………… 21 IgD …………………………………………… 2 IgE ……………………………………………<0.01 L chains ( K or L) only ……………………. 11 H chain (G or A) only …………………….. <1 2 or more monoclonal paraproteins <1 No monoclonal paraprotein ………………. 1 IgM …………………………………………….. 12

Pathophysiological effects of paraproteins Raised serum globulin level Hypoalbuminemia Hyponatremia Dilutional anemia Raised ESR Rouleux formation in RBC Hyperviscosity Interference with Platelet function Interference with Coagulation pathway Proteinuria Renal failure Amyloidosis Cryoglobulinemia

Mechanisms of Bone diseas Development of osteolytic lesions appears to occur through at least two different mechanisms, via the production of various cytokines by myeloma cells adjacent to bone: - Stimulation of osteoclastic activity - Inhibition of osteoblastic activity

Adverse Prognostic factor in Multipla Myeloma Elevated B2 Microglobulin level High Plasma Cell Labeling index Elivated Lactate dehydrogenese Value Elevated Thymidine Kenase Value High C-reactive protein value Plasmablastic Morphology Hypoalbuminemia Advanced age Elevated Creatinine Concentration Hypodipoloidy, Low RNA content of Plasma cell Anemia,Thrombocytopenia,Hypercalcemia Primary resistance to therapy & progressive disease