Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Plasma cell myelomaKahler’s disease ++ 140-239 Neoplasms200-209 Malignant neoplasm of lymphatic and hematopoietic tissue203 Multiple myeloma and immunoproliferative neoplasms203.0 Multiple myeloma203.00 Multiple myeloma without remission203.01 Multiple myeloma in remission203.02 Multiple myeloma, in relapse ++ C90.00 Multiple myeloma not having achieved remissionC90.01 Multiple myeloma in remissionC90.02 Multiple myeloma in relapse ++ 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation6B: Impaired aerobic capacity/endurance associated with deconditioning6H: Impaired circulation and anthropometric dimensions associated with lymphatic system disorders +++ Description ++ Multiple small tumors in the bone marrowOvergrowth of plasma cells in bone marrowPlasma decreasesRBCs/WBCs/platelets decreasePrimary malignant neoplasm of plasma cells arising in the bone marrowMost common form of plasma cell dyscrasia2Initial weakening of the bones and bone marrow of the vertebrae, ribs, skull, pelvis, and femurProgression causes damage to the kidneys, leads to recurrent infections, and can affect the nervous system +++ Essentials of Diagnosis ++ Major criteriaPlasmacytoma by biopsy of tissueBone 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 hrMinor CriteriaBone marrow shows clonal plasma cells 10%-30%M-protein less than that for major criteriaLytic bone lesions on x-ray or MRIReduced levels of nonmonoclonal immunoglobulins (IgM <50 mg/dl, IgA <100 mg/dl, or IgG < 600 mg/dl) +++ General Considerations ++ Spine/pelvis/femur/ribsCompression fracturesPathological fracturesNeural compromise +++ Demographics ++ Median age of diagnosis is 68 years for men, 70 years for womenMore common in menAfrican-American men are affected twice as often as white men +++ Signs and Symptoms ++ Clinicopathologic correlates2Unexplained back painAnemia due to accelerated red cell destruction, nutritional factors and replacement of marrow2Fractures due to bone marrow involvementInfection due to decreased ability to produce specific antibody2Bone pain2Nerve root compression if in the spine bonesFatigueArthritis2Neuropathy2Bone lossPathological fracturesRenal disease2HyperviscosityFrequent urinationMuscular weaknessBruises easilyWeight lossRadiation side effectsFatigueSecondary neoplasmIntegumentary compromise (burns)Radiation fibrosisChemotherapy side effectsNauseaVomitingDiarrheaAlopeciaMouth soresConjunctivitisUlcersLeukopeniaAnemiaThrombocytopeniaHeadachesDizzinessMenstrual irregularitiesInfertilityPeripheral neuropathies +++ Functional Implications ++ Pain with mobilityRisk for pathological fracturesDecreased independenceImpaired performance with ADLsDecreased participation in work and leisureInfection riskEnduranceImpaired gait +++ Possible Contributing Causes ++ No precise etiologyPossibly geneticEnvironmentalRadiationInfectionChronic inflammationPossible due to exposure to Agent Orange +++ Differential Diagnosis ++ Bone neoplasmsChronic lymphocytic leukemia (plasma cell leukemia)Metastatic cancer (carcinoma)... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.