Multiple myeloma, also known as plasma cell myeloma or
Kahler’s disease, is a type of abnormal growth of plasma cells collected
in the bone marrow where they grow and multiple to interfere with the
production of normal blood cells. Paraprotein, an abnormal antibody
produced by the plasma cell myeloma not only can cause kidney problem
but also interference with the Roche automated total bilirubin assay by
precipitate formation of that can lead to clinical confusion, according
to the study by the Harvard Medical School, Boston(1). Other study
indicated that the production of paraproteins caused spurious results on
individual analytes including total bilirubin (TBIL), direct bilirubin
(DBIL), or HDL-cholesterol (HDL-C)(b). There is also a report of a 50
years old
chloride resistant metabolic alkalosis in a patient with hypercalcemia related to Multiple Myeloma (MM)(c).
A. Complications
1. Deteriorated quality of life
patients with MM reported a mean decrease (e.g., worsening) between
baseline and 1-yr follow-up scores for: quality of life (mean, 68 vs.
55, respectively, P < 0.001; 74% of patients had a deteriorated
score)(17).
2. Immue dysfucntion
Mesenchymal stem cells (MSCs), a key regulator for immunomodulatory
function, have decreased osteogenic potential in MM patients opf that
can lead to impaied immunity. According to the study by the Second
Affiliated Hospital of Soochow University, T cells from normal donors
possessed the ability to promote osteoblastic differentiation of
ND-MSCs, but this ability of T cells both directly from MM patients and
co-cultured with MM-MSCs was impaired which in turn lose the ability to
stimulate osteogenesis of MSCs(18).
3. Osteogenesis imperfecta
Osteogenesis imperfecta (OI) also known as brittle bone
disease, is a congenital bone disorder that causes extremely fragile
bones.There is a report of a case of osteogenesis imperfecta with
multiple fractures already from childhood, myelomatosis was diagnosed at
the age of 52 years as a result of a serum M-component (IgG, lambda),
Bence Jones proteinuria, myeloma cells in the bone marrow, and
osteolytic skeletal lesions of that can lead to erosion of bone mass and
fractures. She died 10 months later. A partial postmortem examination
of a larger bone lesion confirmed the diagnosis.(19).
4. Renal insufficiency
Renal insufficiency is an independent risk factor in MM. An impaired
renal function in light chain associated disorders may be caused by
myeloma cast nephropathy (MCN) but also by AL-amyloidosis (AL-A) and
monoclonal immundeposition disease (MIDD), according to the study by
Heinrich Braun Klinikum Zwickau(20).
5. Anemia
Anemia is a common complication in patients with multiple myeloma (MM)
and occurs in more than two thirds of all patients as MM can inetrfere
with the production of normal blood cells. According to the study by
Department of Medicine I, Wilhelminenspital, the most frequent
underlying pathophysiological mechanism is anemia of chronic disease
(ACD), relative erythropoietin (EPO) deficiency (due partly to renal
impairment) and myelosuppressive effects of chemotherapy, but many other
factors may account for or contribute to anemia in myeloma(21).
6. Pseudomonas endocartiditis
There is a report of a case of a is reported a rare case in a
73-year-old man with multiple myeloma who developed endocarditis due to
pseudomonas(21a).
Etc.
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Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/12521367
(b) http://www.ncbi.nlm.nih.gov/pubmed/18251580
(c) http://www.ncbi.nlm.nih.gov/pubmed/22073517
(17) http://www.ncbi.nlm.nih.gov/pubmed/22762785
(18) http://www.ncbi.nlm.nih.gov/pubmed/21199732
(19) http://www.ncbi.nlm.nih.gov/pubmed/472657
(20) http://www.ncbi.nlm.nih.gov/pubmed/23392999
(21) http://www.ncbi.nlm.nih.gov/pubmed/16163188
(21a) http://www.ncbi.nlm.nih.gov/pubmed/23386092
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