produce abnormally

high amounts of a special protein.

The special proteins are typically monoclonal
paraprotein (M protein) and other compounds
such as immunoglobulins.

B lymphocytes start in the bone marrow and
move to the lymph nodes. As they progress,
they mature and display different proteins on
their cell surface.
When they are activated to secrete
antibodies, they are known as plasma cells.
are white blood cells that secrete large
volumes of antibodies
Plasma cells, also called plasma B cells
.
Male:Female 2:1
Radiation- exposure to petroleum
products
Having a family member affected by
multiple myeloma

Collections of abnormal plasma cells
accumulate in the bone marrow,
interfere with the production of normal
blood cells

Increased osteoclastic activity and
decreased osteoblastic activity
through release of cytokines


Symptoms of hypercalcemia
Nausea
Fatigue
Thirst




(hemoglobin <10 g/dL)
Usually normocytic and normochromic
Can be megaloblastic due to either folate or vitamin
B12 deficiency
Due to
Replacement of normal marrow by expanding tumor cells
Inhibition of hematopoiesis by factors made by the tumor
Mild hemolysis


ESR (elevated)

given orally for
Prednisone 4-7 days and
repeated 4-6
week interval


2 melphelan, Cyclophosphamide,
Carmustin, Chlorambucil
3 vincristin, Doxorubicin,
Dexamethasone

2. Radiation
Myeloma is radiosensitive
Relieves pain
Can be used for control of local
disease
Total body irradiation not advised
3. Bone marrow transplantation

To reduce serum calcium level
Corticosteroid
Hydration

Red Blood Cell transfusions
or erythropoietin can be used for
management of anemia.
Surgical options

Compression of intraspinal nerves
laminectomy,removal of myelomatous
tissue and post-op irradiation
In cases with instability - spinal fusion

Supportive therapy
Erythropoetin
Biphosphonates: (pamidronate)
Antibiotics and GM-CSF
Anti-virals esp. herpes
Assess for bone involvement
Assess for hypercalcemia, measure the
calcium level frequently
Fluids are administered to increase
urinary output
Caution should be taken while moving
or transferring the patient, because
there is risk of pathologic fracture

Analgesics should be given to reduce
bone pain
Braces (especially spinal braces ) may
also help to reduce pain
Monitor intake and output
Administer IV fluids
Small frequent diet should be given to
reduce nausea
Closely monitor the clients mental status
Counseling should be given to the
patient and family