MULTIPLE MYELOMA LAB FINDINGS USMLE FREE
Serum free light chain assay: Serum free light chains are light chains which are free of heavy chains.
Urine protein electrophoresis (UPEP) and immunofixation.Immunofixation qualifies the immunoglobulin as IgG, IgA, etc. Serum protein electrophoresis (SPEP) and immunofixation: the SPEP “spike” quantifies the amount of paraprotein, or M-protein, that is coming from a single clone of plasma cells.Hyperviscosity (from paraproteinemia, and yes, there is a test for that!).Cryoglobulinemia: proteins, generally immunoglobulins, that precipitate out of solution in low temperatures.↑ Alkaline phosphatase: if seen, should make one suspect pathological fractures.Hypogammaglobulinemia: ↓ levels of normal immunoglobulins IgG, IgA and IgM Multiple myeloma is a common malignancy in patients above 40 70 of cases are diagnosed between ages 50 and 70 with a median age of diagnosis being 70 years there is a male predilection (M: F 2:1) 7,12,14.It accounts for 1 of all malignancies and 10-15 of all hematological neoplasms 12,14.Distal (Type 4) renal tubular acidosis: hyperkalemia, non-anion gap metabolic acidosis, ↑ urinary anion gap, ↓ urine pH, ↓ renin, low-normal aldosterone levels and blood pressure.Acquired Fanconi syndrome: hypophosphatemia, hypokalemia, Proximal (Type 2) renal tubular acidosis, phosphaturia, aminoaciduria, glucosuria on urinalysis with a normal blood glucose.Proximal (Type 2) renal tubular acidosis: hypokalemia, low urine pH, non-anion gap metabolic acidosis.Nephrotic syndrome: hypoalbuminemia, hyperlipidemia, proteinuria (elevated protein on urine dipstick, elevated urine protein to creatinine ratio), lipiduria (look for Maltese cross formations under polarized light microscopy), peripheral edema.Anion gap: normal, high or low anion gap.Renal failure: ↑ BUN and creatinine, metabolic acidosis.Septicemia: especially from encapsulated organisms, which are normally cleared by the spleen with the aid of well-functioning antibodies.High serum total protein and low albumin/globulin ratio.High Erythrocyte Sedimentation Rate (ESR).Peripheral blood smear: normocytic, normochromic anemia, macrocytic anemia, rouleaux formation, neutropenia, thrombocytopenia, abnormal plasma cells (15%).(iii) Bone scans tended to pick up lesions in ribs. (ii) Lytic bone lesions were seriously underestimated by bone scans. Prognosis varies according to the age of onset and type of leukemia.Multiple myeloma is associated with more laboratory abnormalities than any other disease. A comparative study of radionuclide bone scanning and skeletal radiology in patients with multiple myeloma revealed four principal findings: (i) There were no cases of negative bone scans with positive skeletal radiographs. Management is chemotherapy administered in phases (induction, consolidation, and maintenance) based on subtypes. Immunophenotyping, histochemistry, and genetic analysis all aid in identifying and guiding the treatment of AML. Diagnosis is via peripheral blood smear and bone-marrow biopsy examination (shows myeloblasts).
MULTIPLE MYELOMA LAB FINDINGS USMLE SKIN
Additional findings in AML may include gingival hypertrophy and skin infiltration (leukemia cutis). The onset of symptoms takes days to weeks.
Clinical presentation consisting of fatigue, bleeding, fever, and infection is related to anemia, thrombocytopenia, and a lack of functional WBCs. Seen predominantly in older adults, AML includes an accumulation of myeloblasts and a replacement of normal marrow by malignant cells, which leads to impaired hematopoiesis. Radiation therapy is used in adults but not in children, and stem cell transplantation is used for patients with aggressive disease.Īcute myeloid leukemia (AML) is a hematologic malignancy characterized by the uncontrolled proliferation of myeloid precursor cells. Management is with chemotherapy or targeted drugs. Diagnosis is made by lymph node biopsy, bone marrow biopsy, or both. T-cell NHLs include adult T-cell lymphoma and mycosis fungoides. B-cell NHLs include diffuse large B-cell lymphoma, follicular lymphoma, Burkitt lymphoma, mantle cell lymphoma, and marginal zone lymphoma. Clinical features include lymphadenopathy and hepatosplenomegaly, but some individuals present with extranodal involvement and abnormal lab findings. Like Hodgkin lymphoma, which has distinct pathologic features and treatments, NHL often presents with constitutional signs of fever, night sweats, and weight loss.
X-rays are used to: check for broken or weakened bones in the skull, spine, legs, arms, ribs and pelvis. Most bones in the body are x-rayed when diagnosing multiple myeloma. Most pediatric cases are aggressive and high-grade (but curable) in adults, low-grade subtypes are more common. An x-ray uses small doses of radiation to make an image of the body’s structures on film. Non-Hodgkin lymphomas (NHLs) are a diverse group of hematologic malignancies that are clonal proliferative disorders of mature or progenitor B cells, T cells, or natural killer (NK) cells.
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