Page 451 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 22 ■ Lymphoid and Plasma Cell Neoplasms 435

FIGURE 22.17 Lesions in ultiple yelo . A. A single osteolytic lesion is etect ble in this skull r iogr ph n exhibits
“punche -out” ppe r nce. B. Another osteolytic lesion is etect ble in the tibi .

etiology is unknown; however, r i tion y be ctor, Sever l ctors contribute to the i unoco pro ise

n the possibility o vir l c use h s been suggeste . T e st te. Multiple yelo le s to co pens tory ecre se

likelihoo o genetic ctor in so e c ses is supporte by in synthesis n incre se in c t bolis o nor l i u-

well- ocu ente reports o 23 ili l clusters with ul- noglobulins. As the tu or bur en incre ses, the ntibo y
tiple yelo . response beco es ore i p ire n the egree o hu or l

Chro oso l bnor lities re oun in t le st h l o i unosuppression incre ses.

p tients with ultiple yelo . Nu erous ch nges n struc- Co ple ent ctivity is lso ef cient in p tients with

tur l bnor lities, inclu ing gi nt chro oso es, tr nsloc - ultiple yelo . As the ise se progresses, gr nulocyto-

tions, n eletions, h ve been ssoci te with pl s cells. peni y evelop s result o bone rrow ilure.

Multiple yelo cells uni or ly overexpress CD38. re t ent with corticosteroi s results in tr nsient -cell

sequestr tion, i inishe synthesis o i unoglobulins, n

Clinical Signs and Symptoms ecre se herence n egr nul tion o neutrophils. As

result o cytotoxic che other py, there is v ri ble ecre se in
Multiple yelo is historic lly ef ne by the presence o the nu bers n unction o cells, B cells, n gr nulocytes.

en -org n ge, specif c lly hyperc lce i , ren l il-

ure, ane i , n bone lesions. T ese re c lle the CRAB Laboratory Data

e tures th t c n be ttribute to the neopl stic process. In

2014, the Intern tion l Myelo Working Group up te Te ise se ef nition o MM n rel te pl s cell isor ers

the i gnostic criteri or MM to specif c bio rkers or is b se on l bor tory outco es ( ble 22.8). Ane i is present

the i gnosis o p tients who i not h ve the CRAB e - t the ti e o i gnosis in pproxi tely two thir s o p tients.

tures. T e up te ise se ef nition or MM lso uto ti- Incre se pl s volu e c use by onoclon l protein co -

c lly resulte in revision o the i gnostic criteri or the only pro uces hypervole i . T e leukocyte count c n be

sy pto tic ph se o MM, SMM. nor l, lthough bout one thir o p tients h ve leukopeni .

Sy pto s o ultiple yelo inclu e bone p in (typi- Rel tive ly phocytosis is usu lly present. So eti es, eosino-

c lly in the b ck or chest) th t is present t the ti e o i gno- phili is note . In r re c ses in the ter in l st ges, pl s bl sts

sis in ore th n two thir s o p tients, we kness, n tigue. n pl s cells (Fig. 22.18) y ount to 50% o the leuko-

Weight loss n night swe ts re not pro inent until the is- cytes in the peripher l bloo . Roule ux or tion ( iscusse

e se is v nce . Abnor l blee ing y be pro inent in Ch pter 7) on peripher l bloo s e rs is co on.

e ture. In so e p tients, the jor sy pto s result ro Blee ing is co on. Pl telet bnor lities, i p ire

cute in ection, ren l insu ciency, hyperc lce i , or y- ggreg tion o pl telets, n inter erence with pl telet unc-

loi osis. In ition to the conclusive l bor tory f n ings, tion by the bnor l onoclon l protein contribute to

inclu ing bone rrow ex in tion results, pproxi tely blee ing. Inhibitors o co gul tion ctors n thro bocy-

90% o p tients su er ro bro ly isse in te estruc- topeni ro rrow inf ltr tion o pl s cells or che o-

tion o the skeleton (Fig. 22.17). ther py y lso contribute to blee ing. So e p tients h ve