IMMUNOLOGIC DIAGNOSIS AND TYPING

OF MULTIPLE MYELOMA AND A STUDY

OF SOME OF ITS COMPLICATIONS

 

 

 

THESIS SUBMITTED FOR PARTIAL FULFILMENT FOR THE

DOCTOR DEGREE IN CLINICAL PATHOLOGY

BY

 

Elham Omer Hamed

M.B.B.Ch.&M.Sc. in clinical pathology

Faculty of Medicine, South Valley University

 

 

Under supervision of

 

Prof. Khadega Abdel-Shafea Abdel-Megeed

Professor of Clinical Pathology, Faculty of Medicine,

Assiut University

 

 

 

Dr. Lobna Mohammad Tag-Eldeen

Lecturer of Clinical Pathology,

Faculty of Medicine, Assiut University

 

2000

 

 

INTRODUTION

 AND AIM OF THE WORK 

   

 

         Multiple myeloma or plasma cell myeloma is characterized by a neoplastic proliferation of a single clone of plasma cells engaged in the production of a monoclonal protein. Multiple myeloma accounts for about 10% of hematological malignancies. Bone pain anemia &renal insufficiency constitute a triad that is strongly suggestive of multiple myeloma. The minimal criteria for diagnosis of multiple myeloma include the presence of at least 10% abnormal immature plasma cells in the bone marrow and at least one of the following abnormalities:

M protein in serum, M protein in urine, or osteolytic lesion.

 

         The present study aims at establishing the diagnosis of multiple myeloma in symptomatizing patients or in cases with M component in their sera .

        The newly introduced technique of identification of a monoclonal immunoglobulin in the plasma cells of bone marrow in multiple myeloma cases by immunoperxidase or immunofluorescence offers an attractive and definitive test for diagnosis &differential diagnosis of multiple myeloma particularly in the following conditions: -

       Cases with benign of non secretory myeloma, and patient exhibiting increased number of plasma cells in the bone marrow as in paraproteinemia (MGUS), cases collagen diseases and in certain infections.

 

 

 

 

 

LABORATORY PROCEDURES:

 

We do the following analysis

 

1st-       General investigations:

1-    Peripheral hemogram.

2-    Critical examination of bone marrow.

3-    Assessment of liver functions.

4-    Assessment of Kidney functions:

       A- complete urine analysis.

       B- serum urea, creatinine, urinary creatinine        

         clearance was calculated, & serum uric acid.

     5- Serum calcium, phosphate and alkaline phosphatase.

     6- Total protein in urine, urinary albumen & very low              

          conc. Albumin

     7- Serum & urine IgG.

     8- The calculation of albumin IgG clearance & selectivity  

          index.

     9- Tubular proteins:

          A-Estimation of  a₁ macroglobulin in urine.

          B-Estimation of retinol binding protein in urine.

          C-Estimation of b₂ microglobulin in urine.

 

2nd-    Special investigations: 

1-screening of sera for paraprotein & quantitation by

    denstometry.

2-Test for cryoglobulin & quantitation if present.

3-Detection of Bence-Jones protein in urine  and      

   identification of the type of light chain.

4-Sia test for IgM macroglobulinaemia.

5-Serum b₂ microglobulin & LDH level.

6-Typing of paraprotein in serum by immunofixation   

   electrophoresis.

 

7- Quantitation of serum immunoglobulins IgG, IgA, 

    IgM.

8-Identification of the bone marrow by

   immunofluorescence or immunoperoxidase.