When I grow up.. I wannabe a Dr.

Multiple Myeloma

Symptoms:
-Due to osteolytic bone lesion ( back pain, pathological fractures of long bones)
-Hypercalcaemia ( bones,stones,groans,pyschic moans, sytemic feat ie:
constipation, aneroxia, weight loss, polyuria, polydipsia)
-Due to marrow infiltration (anaemia, neutropenia-infections, thrombocytopenia- bleed
-Renal impairment
-Systemic amylodosis

Tests:
FBC (anaemia,infection,platelet)
blood film (rouleaux formation)
ESR
U+E and Creat
Calcium levels
X-Ray/CT/MRI
Serum n Urine electrophoresis
B2 microglobulin level (prognostic)
Marrow biopsy

Diagnosis :
>Monoclonal protein band on electrophoresis
>Increased plasma cells on BM biopsy
>End organ damage (hyperCa2+, renal damage, anaemia, bone lesion)

Treatment:
a) Supportive
- Analgesics for bone pain (avoid NSAID's)
- Bisphosphonate ie pamidronate to reduce fracture rates
- Local radiotherapy
- Transfusion/erytropoeitin for anaemia
- Rehydration/dialysis in renal failure
- Broad spec antibiotics ie cefuroxime for infections / IV IG if recurrent

b) Chemo
- Elderly : melphalan/cyclophosphamide with prednisolone +/- thalidomide
- Young : High dose therapy and stem cell rescue
> VAD regime Vincristine, Adriamycin, Dexamethasone
> Autologus/allogenic stem cell transplant


yours truly
>shahied<