Multiple myeloma is a progressive neoplastic disease characterized by marrow plasma cell tumors and over-production of an intact monoclonal immunoglobulin (IgG, IgA, IgD, or IgE) or Bence Jones protein (free monoclonal kappa or lambda light chains). Multiple myeloma is often associated with multiple osteolytic lesions, hypercalcemia, anemia, renal damage, and increased susceptibility to bacterial infections. The incidence of myeloma has been estimated at 2 to 3 per 100,000 persons. Men and women are equally affected. Most patients are over 40 years old.
The most common presentation of multiple myeloma is a persistent unexplained skeletal pain (especially in the back or thorax), renal failure, or recurrent bacterial infections, especially pneumococcal pneumonia. Anemia with weakness and fatigue predominates in some patients, and a few have manifestations of the hyperviscosity syndrome. Osteolytic lesions commonly cause pathologic fractures and vertebral collapse, which may lead to spinal cord compression and paraplegia.
Multiple myeloma is often associated with multiple osteolytic lesions, hypercalcemia, anemia, renal damage, and increased susceptibility to bacterial infections.
Environmental or occupational causes: Case-controlled studies have suggested a significant risk of developing myeloma in individuals with significant exposures in the agriculture, food, and petrochemical industries. Long-term (>20 y) exposure to hair dyes has been tied to an excessive risk of developing myeloma.
Radiation has been linked to the development of myeloma.
Laboratory findings include a normocytic normochromic anemia with formation of rouleaux evident on peripheral smear. The WBC and platelet counts usually are normal. The ESR is often markedly elevated (> 100 mm/h, Westergren), and BUN, serum creatinine, and serum uric acid are frequently elevated. A low Òanion gapÓ (the difference between the sum of the measured cations and anions in the plasma or serum calculated as follows: (Na + K) Ð (Cl + HCO3) = < 20 MMOL/l.) is present in some patients and may be a helpful diagnostic clue. Hypercalcemia occurs in about one-third of patients. The serum level of beta-2-microglobulin is frequently elevated and correlates with myeloma cell mass. Proteinuria is common because of excess synthesis and secretion of free monoclonal light chains (Bence Jones protein).
X-ray of the bones may show typical punched-out lytic lesions or diffuse osteoporosis. The bone marrow usually contains increased numbers of plasma cells at various stages of maturation. Rarely is the number of plasma cells normal.
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