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9. Abnormal Immunoglobulin Production


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How many possible types of immunoglobulins are there?
What are they?
10: IgGkappa, IgGlambda, so forth for G, A,M,E,D
How many types of Ig can individual plasma cells produce?
How to plasma cells normally respond to antigen?
What is Monoclonal Gammopathy?
An increase in serum of ONE specific Ig molecule/fragment.
What diseases present with monoclonal gammopathy?
1. Multiple myeloma (plsma cell)
2. Waldenstroms Macroglobulinem.
3. Carcinoma
4.Benign monoclonal gammopathy
What 3 methods are used to detect monoclonal gammopathy?
1. Serum protein electrophores.
2. Immunoelectrophoresis
3. Serum/urine Ig determinations
What are the 3 types of Monoclonal gammopathies we learn about?
1.Plasma cell myeloma (Multiple)
2. Waldenstroms Macroglobulinem.
3. Heavy Chain disease
What's the major problem with multiple myeloma?
MANY BODY SYSTEMS are involved.
What patient popln gets Multiple myeloma?
Older - rarely under 40.
What is the most common symptom of plasma cell myeloma?
Pathologic bone breaks - when picking up a bag of groceries or something.
In multiple myeloma, what are the lab findings w/ respect to:
RBC, WBC, Platelets, CAlcium, ESR, protein?
RBC: n/n anemia w/ ROULEAUX
WBC: variable
Plt: normto decreased
Ca+: lots in the blood/urine
IncreasedESR, proteinuria.
What special type of proteins cause the proteinuria in Multiple myeloma?
BENCE JONES proteins - excess light chains excreted.
What is the usually elevated protein in Mult. myeloma?

2nd most common?
IgM - causes an M spike on electrophoresis.

What bone marrow abnormality shows up w/ plasma cell myeloma?
POCKETS of plasma cells.
What causes the bone breaks?
OAF - osteoclast activating factor - causes increased bone resorption, stimulated by abnormal plasma cells.
What is Waldenstrom's Macroglobulinemia?
A plasma cell dyscrasia that is possibly a varient of CLL or WDLL
What patients usually get Waldenstrom's MAcroglobulinemia?
Older than 40
What are general physical, visible symptoms of Waldo's macroglob?
General Lymphadenopathy
Why the splenomegaly?
Hyperviscous blood from high protein content - causes visual and neurological problms.
What 3 chronic lymphoma diseases can have accompan. splenomegal?
1. Hairy cell
2. Prolymphocytic
3. Waldenstrom's
What 2 plasma cell dyscrasias can have assoc. rouleaux?
1. Multiple Myeloma
2. Waldenstrom's
What are the Lab findings in Waldo's macroglob?
-Anemia, WBCs, ESR,
-N/N anemia w/ thrombocytopenia and pancytopenia
-Relative lymphocytosis
What does the bone marrow look like in Waldo's macroglob?
Infiltrated by lymphs, plasmacytoid lymphs, and plasma cells.
What does Ig electrophoresis show in Waldo's macroglob?
Elevated serum Ig - only M (mu) chain and only one type of light chain (kappa or lambda).
Which plasma cell dyscrasia sees pockets of plasma cells in BM?
only multiple myeloma.
What are Heavy Chain Diseases?
Uncommon gammopathies where only one single heavy chain is present, no light chain.
What are the 3 types of Heavy chain disease?
1. Gamma
2. Alpha
3. Mu
What type of disease is Gamma heavy chain most similar to?
How is it diagnosed?
Malignant lymphoma (instead of myeloma)
-Diagn. w/immunoelectrophoresis
What patients usually get Alpha heavy chain disease?
What are distinguishing features?
Younger - malabsorption and diarrhea; massive infiltration of intestines w/ lympocytes and plasma cells.
What is the least common heavy chain disease?
IgM - Mu heavy chain disease.
-Identified by IEP, vaculated plasma cells in the BM.

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