> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/heme/20-plasma-cell-disorders.md).

# 20 Plasma Cell Disorders

## Multiple Myeloma

![](https://f001.backblazeb2.com/file/wikiFiles/lsvBqAx.jpg)

* symptoms from Ig

![](https://f001.backblazeb2.com/file/wikiFiles/IFFdZxy.jpg)

* paraproteins: Ig produced in excess by MM

![](https://f001.backblazeb2.com/file/wikiFiles/bhESpg9.jpg)

* either 2 k or 2 lambda
* heavy chain: IgG heavy chain makes IgG antibody
* antibody description: IgGk for k light chain. IgG-lambda for lambda light chain

![](https://f001.backblazeb2.com/file/wikiFiles/1GDcM8E.jpg)

* toxic to kidney
* deposit in tissues and form amyloid structures

### Symptoms

![](https://f001.backblazeb2.com/file/wikiFiles/ZH1XJ6Y.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/LEhQG2P.jpg)

* elderly with minor fall/fracture of vertebral column

![](https://f001.backblazeb2.com/file/wikiFiles/dXG9yS6.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/Mqxm322.jpg)

* obstruction leads to renal failure
* detected by UPEP

![](https://f001.backblazeb2.com/file/wikiFiles/sOk7j1f.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/zo9Jf9E.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/ZZAa7AM.jpg)

* lower GFR > renal failure
* On light microscopy, numerous large, glassy casts that stain intensely **eosinophilic** are seen.  Deposition of light chain fragments in the glomerular mesangium and capillary loops can also cause renal failure in MM (AL amyloidosis).

![](https://f001.backblazeb2.com/file/wikiFiles/mwv3Vi3.jpg)

* bone marrow replaced by plasma cells: underproduction of RBC

![](https://f001.backblazeb2.com/file/wikiFiles/qOmWbrG.jpg)

### Diagnosis

![](https://f001.backblazeb2.com/file/wikiFiles/cRqMKK9.jpg)

* gamma spike last spike
* MM: gamma fraction very large
* M spike: monoclonal production of Ig

![](https://f001.backblazeb2.com/file/wikiFiles/qszv7ab.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/MayOrPn.jpg)

* UPEP being replaced by this

![](https://f001.backblazeb2.com/file/wikiFiles/yBO1Fwd.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/V8kuIPo.jpg)

* SPEP not good enough: other problems also produce monoclonal protein

## MGUS

![](https://f001.backblazeb2.com/file/wikiFiles/gg9rYVy.jpg)

* no symptoms

## Waldenstrom Macroglobulinemia

![](https://f001.backblazeb2.com/file/wikiFiles/2kFbfOP.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/2QvDgma.jpg)

* IgM, not IgG, IgA, or light chains (MM)

![](https://f001.backblazeb2.com/file/wikiFiles/dNtboCF.jpg)