Which of the following is seen in multiple myeloma: March 2007
Ans: A: Raised Serum Calcium Multiple myeloma/ MM/ myeloma/ plasma cell myeloma/Kahler's disease is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. The peak age of onset of multiple myeloma is 65 to 70 years of age. Multiple myeloma affects slightly more men than women. A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB ? C = Calcium (elevated), R = Renal failure, A = Anemia, B = Bone lesions. Myeloma bone pain usually involves the spine and ribs, and worsens with activity. Myeloma bone disease is due to proliferation of tumor cells and release of IL-6, which stimulates osteoclasts to break down bone. The breakdown of bone also leads to release of calcium into the blood, leading to hypercalcemia and its associated symptoms. These bone lesions are lytic in nature and are best seen in plain radiographs, which may show "punched-out" resorptive lesions. The anemia found in myeloma is usually normocytic and normochromic. The presence of unexplained anemia, kidney dysfunction, a high erythrocyte sedimentation rate (ESR) and a high serum protein (especially raised immunoglobulin) should raise the suspicion. Protein electrophoresis of the blood and urine may show the presence of a paraprotein (monoclonal protein, or M protein) band, with or without reduction of the other (normal) immunoglobulins (known as immune paresis). One type of paraprotein is the Bence Jones protein which is a urinary paraprotein composed of free light chains. Multiple myeloma can produce all classes of immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM. IgD and IgE myeloma are very rare. Myeloma activity sometimes appear as "lytic lesions" (with local disappearance of normal bone due to resorption), and on the skull X-ray as "punched-out lesions" (pepper pot skull).
Raised serum calcium
Decreased serum calcium
Normal serum calcium
None of the above