Prepared by : IBRAHEEM NIDAL ABU ATWAN SAEED YEHYA HAMMODA Multiple Myeloma Prepared by : IBRAHEEM NIDAL ABU ATWAN SAEED YEHYA HAMMODA

Introduction : Multiple myeloma is a cancer formed by malignant plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system. The immune system is made up of several types of cells that work together to fight infections and other diseases. Lymphocytes (lymph cells) are the main cell type of the immune system. The major types of lymphocytes are T cells and B cells.

When B cells respond to an infection, they mature and change into plasma cells. Plasma cells make the antibodies (also called immunoglobulins) that help the body attack and kill germs. Lymphocytes are in many areas of the body, such as lymph nodes, the bone marrow, the intestines, and the bloodstream. .

Plasma cells, however, are mainly found in the bone marrow. Bone marrow is the soft tissue inside some hollow bones. In addition to plasma cells, normal bone marrow has cells that make the different normal blood cells

When plasma cells become cancerous and grow out of control, they can produce a tumor called a plasmacytoma. These tumors generally develop in a bone, but they are also rarely found in other tissues. If someone has only a single plasma cell tumor, the disease is called an isolated (or solitary) plasmacytoma. If someone has more than one plasmacytoma, they have multiple myeloma.

Pathophysiology

Multiple myeloma: Symptoms Fatigue Back pain Increased infections Hypocalcaemia Renal insufficiency Hyperviscosity

Treatment At present there is no curative therapy, but symptomatic treatment may be as. \blood trasfusion if anaemia present \antibiotic to treet infection \dialysis in case of renal failure \radiotherapy for osteolytic bone

The case study

Case presentation A 55-year-old man present to the hospital with new symptoms of weakness and fatigue. He also has a bone pain and pain in each side of here abdomen . He say that he have a fever from several day .

Cont. The doctor order this test to be done . \CBC. \Chem. \protein electrophoresis

CBC Normal range The result low 3.9-5 x 101/2L 3.3 x 101/2L RBCS 13-17 g/dL 10.4 g/dL HGB 35-44.5 % 31.1% HCT ESR. 120 NR 0-20 Hyperproteinemia hypocalcaemia protiuria azotemia normal 3.5-10.5 109/L 6.2 x 109/L WBCS Moderet low 15000-45000 12000 PLT

cont Chem: \BUN 40, N.R 7-20 mg/dl \creatinine 2.0, N.R 1-2 mg/dl N.R 2-4 mg/dl \uric acid 11.6, \calcium 13.5 N.R 9-11 mg/dl \albumin 2.8, N.R 1 mg/dl \total bilirubin 0.18, N.R 1-2mg/dl \alk phos 153, N.R 50-160 mg/dl AST 35, N.R 0-40 mg/dl ALT 40. N.R 0-30 mg/dl \Total P 12.3, N.R 6.3-8mg/dl \gamma globulin 6.2, N.R 0.7 -1.6mg/dl

Serum Protein Electrophoresis (SPEP)  Albumin B  2 1 Albumin 

Multiple Myeloma: Incidence and Epidemiology 1% of all malignancies 3-4 per 100,000 population 16,000 new cases/yr; 11,000 deaths/yr Median age: 65 yo; 3%<40 yo M>F Risk: radiation exposure