Dr Shwe Sin

FMHS
Universiti Tunku Abdul Rahman
By the end of the lesson, the students
should be able to :
Describe the definition, pathophysiology, clinical
features, laboratory diagnosis and complications of
multiple myeloma.
 Definition
Multiple myeloma (myelomatosis) is a neoplastic
disease characterized by malignant plasma cells
(Myeloma cells) accumulation in the bone marrow
and other body tissues

If malignant plasma cells appear in peripheral

blood called PLASMA CELL LEUKAEMIA
Pathophysiology
The pathological and clinical features are due to neoplastic
proliferation of plasma cells -- tissue infiltration, production
of large amounts of paraproteins and impairment of
immunity----- causing:

Raised serum globulin level

Cryoglobulinaemia
Hypoalbuminaemia
Anaemia
Increased ESR
Rouleaux formation in blood film
 Interference with platelet function and coagulation
pathway leading to coagulopathy
Hyperviscosity syndrome
Renal failure : precipitation of paraprotein in renal
tubules causing tubular dilatation, atrophy and
dysfunctions
Hyponatraemia
Proteinuria
Amyloidosis : due to AL amyloid protein
Impairment of immunity: Abnormal paraproteins with
reduced normal immunoglobulin leading to impairment of
immunity
Clinical features:
1. Age : middle & old age (50 -70 yrs)
2. Sex : M=F
3. Bone pain : especially backache (most common clinical
presentation)
4. Pathological fracture
5. Anaemia : due to dilutional effect of paraprotein, bone
marrow infiltration with depression of normal
erythropoiesis, renal failure, cytotoxic therapy and
malignant disease itself.
6. Features of renal failure (CRF) and/or hypercalcaemia
7. Abnormal bleeding tendency :
Due to : (1) coating of platelet by paraprotein leading to
abnormal platelet function (2) thrombocytopenia (3)
Coagulopathy due to interfere with factor VIII activity,
impairment of fibrinogen activity and abnormal
paraproteins are act as anticoagulant
8. Recurrent infections: related to deficient Ab
production, abnormal cell-mediated immunity and
neutropenia
9. Amyloidosis : occurs in 5%
10. Hyperviscosity syndrome : 2% of cases
LABORATORY DIAGNOSIS
A. HAEMATOLOGICAL DIAGNOSIS
Blood picture: Anaemia (usually NNA) with
rouleaux formation
ESR : increased
Bone marrow examination
B. BIOCHEMICAL INVESTIGATION
I. Blood:
1. Total Serum Protein/ Serum paraprotein
2. Serum Protein Electrophoresis
3. Immuno electrophoresis
4. Serum Ca++
5. Serum PO4
6. Alkaline Phosphatase
7. Serum creatinine
8. Serum uric acid
II. Urine
1. BenceJone proteinuria
2. Urine electrophoresis
3. Free light chain in urine (Kappa/ Lambda chains)

C. RADIOLOGICAL DIAGNOSIS
Bone X-ray

PROGNOSIS:
Median survival with non-intensive chemotherapy is 3-4 years
References
Essential Hoffbrand (A.V Hoffbrand and P.A.H Moss)
6th Edition
Robbins basic pathology, 9th Edition