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Condition/Disorder Synonyms

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  • Plasma cell myeloma

  • Kahler's disease

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ICD-9-CM Codes

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  • 140-239 Neoplasms

  • 200-209 Malignant neoplasm of lymphatic and hematopoietic tissue

  • 203 Multiple myeloma and immunoproliferative neoplasms

  • 203.0 Multiple myeloma

  • 203.00 Multiple myeloma without remission

  • 203.01 Multiple myeloma in remission

  • 203.02 Multiple myeloma, in relapse

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ICD-10-CM Codes

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  • C90.00 Multiple myeloma not having achieved remission

  • C90.01 Multiple myeloma in remission

  • C90.02 Multiple myeloma in relapse

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Preferred Practice Patterns1

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Key Features

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Description

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  • Multiple small tumors in the bone marrow

  • Overgrowth of plasma cells in bone marrow

  • Plasma decreases

  • RBCs/WBCs/platelets decrease

  • Primary malignant neoplasm of plasma cells arising in the bone marrow

  • Most common form of plasma cell dyscrasia2

  • Initial weakening of the bones and bone marrow of the vertebrae, ribs, skull, pelvis, and femur

  • Progression causes damage to the kidneys, leads to recurrent infections, and can affect the nervous system

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Essentials of Diagnosis

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  • Major criteria

    • Plasmacytoma by biopsy of tissue

    • Bone marrow shows clonal plasma cells >30%

    • High M-protein (IgG >3.5 g/dl, IgA > 2.0 g/dl)

    • Bence Jones Protein uria > 1.0 g/24 hr

  • Minor Criteria

    • Bone marrow shows clonal plasma cells 10%-30%

    • M-protein less than that for major criteria

    • Lytic bone lesions on x-ray or MRI

    • Reduced levels of nonmonoclonal immunoglobulins (IgM <50 mg/dl, IgA <100 mg/dl, or IgG < 600 mg/dl)

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General Considerations

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  • Spine/pelvis/femur/ribs

    • Compression fractures

    • Pathological fractures

    • Neural compromise

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Demographics

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  • Median age of diagnosis is 68 years for men, 70 years for women

  • More common in men

  • African-American men are affected twice as often as white men

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Clinical Findings

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Signs and Symptoms

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  • Clinicopathologic correlates 2

  • Unexplained back pain

  • Anemia due to accelerated red cell destruction, nutritional factors and replacement of marrow2

  • Fractures due to bone marrow involvement

  • Infection due to decreased ability to produce specific antibody2

  • Bone pain 2

  • Nerve root compression if in the spine bones

  • Fatigue

  • Arthritis 2

  • Neuropathy 2

  • Bone loss

    • Pathological fractures

  • Renal disease 2

  • Hyperviscosity

  • Frequent urination

  • Muscular weakness

  • Bruises easily

  • Weight loss

  • Radiation side effects

    • Fatigue

    • Secondary neoplasm

    • Integumentary compromise (burns)

    • Radiation fibrosis

  • Chemotherapy side effects

    • Nausea

    • Vomiting

    • Diarrhea

    • Alopecia

    • Mouth sores

    • Conjunctivitis

    • Ulcers

    • Leukopenia

    • Anemia

    • Thrombocytopenia

    • Headaches

    • Dizziness

    • Menstrual irregularities

    • Infertility

    • Peripheral neuropathies

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Functional Implications

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  • Pain with mobility

  • Risk for pathological fractures

  • Decreased independence

  • Impaired performance with ADLs

  • Decreased participation in work and leisure

  • Infection risk

  • Endurance

  • Impaired gait

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Possible Contributing Causes

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  • No precise etiology

  • Possibly genetic

  • Environmental

  • Radiation

  • Infection

  • Chronic inflammation

  • Possible due to exposure ...

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