Paraproteinemia incl Multiple myeloma

A paraprotein is a monoclonal immunoglobulin or light chain present in the blood or urine , it is produced by a clonal population of mature B cells , most commonly plasma cells.Normally serum immunoglobulins are polyclonal and represent the combined yield from millions of different plasma cells.

Individuals > 50 yrs incidence is 3.2 % Varies with age and sex-Elderly > Young , Male > Female Ethnic variation - threefold higher in African Americans than the white population

When to consider checking ? Malaise and fatigue Bone disease- persistent back pain , osteopenia or lytic lesions Impaired renal function Normocytic , normochromic anaemia ± pancytopenia Hypercalcaemia Recurrent bacterial infection Hyperviscocity Nephrotic syndrome Cardiac failure Malabsorption Peripheral neuropathies , carpal tunnel syndrome Incidental persistent raised ESR

Complications -Neuropathy Nephrropathy Cytopenias○ ITP○ AIHA Cold agglutinins Cryoglobulins

Multiple Myeloma Neoplastic proliferation of plasma cells in the bone marrow and occasionally in other organs as the liver , spleen and lymph nodes. Predominantly affects older adults Accounts for 10 % of all haematological malignancies in UK & 1 % of all malignancies Median age of presentation is 66 yrs with < 3 % of patients being < 40 More in black people , pacific...