Page 288 - Essential Haematology

274 / Chapter 21 Multiple myeloma and related disorders

disease). Also, amyloid, hyperviscosity and recur-
rent infection may also be present.
Asymptomatic (smouldering) myeloma is diag-
nosed if there is an M protein in serum at myeloma
Absorbance levels ( > 30 g/L) and/or 10% or more of clonal

plasma cells in the marrow but no related organ or
tissue impairment (e.g. CRAB or myeloma - related
symptoms).

Clinical f eatures
β γ Origin
Alb α 1 α 2
Distance from origin 1 Bone pain (especially backache) resulting from

Patient with multiple myeloma Normal vertebral collapse and pathological fractures
IgGκ monoclonal protein 38 g/L pattern
(Fig. 21.3 a,b).
2 Features of anaemia, e.g. lethargy, weakness, dys-

Figure 21.1 Serum protein electrophoresis in multiple pnoea, pallor, tachycardia.
myeloma showing an abnormal paraprotein in the
3 Recurrent infections: related to defi cient anti-
γ - globulin region with reduced levels of background

body production, abnormal cell - mediated immu-

β - and γ - globulins.
nity and neutropenia.

(a)
(b)

Figure 21.2 (a) The bone marrow in multiple myeloma

showing large numbers of plasma cells, with many
abnormal forms. (b) Low power view showing sheets
of plasma cells replacing normal haemopoietic tissue.
(c) Immunohistochemical staining of the bone marrow
in myeloma with antibody to CD138 revealing
(c) extensive numbers of plasma cells.