![]() ![]() There’s a predictable pattern of proteins in normal serum: albumin (the most abundant protein in the blood) migrates to a certain predictable point other proteins migrate to different places (which are given different names – the alpha 1 region, the alpha 2 region and the beta region). ![]() You can detect the monoclonal immunoglobulin using serum electrophoresis (which separates the blood proteins into groups based on charge and size). Monoclonal gammopathy is so characteristic of myeloma that you can use it for both diagnosis of disease and follow-up of patients. This huge mass of all-the-same immunoglobulin secreted by myeloma cells is called a “monoclonal gammopathy ” the normal immunoglobulins are called “polyclonal.” This is very different than what you see in a patient without myeloma, where there are a bazillion different types of plasma cells, all making different types of immunoglobulin molecules. The malignant plasma cells almost always secrete immunoglobulin, and because they are monoclonal, they all secrete exactly the same form of immunoglobulin. That’s one thing to remember about myeloma – malignant plasma cells don’t always resemble their nice little benign counterparts. A few look a lot like plasma cells, with clock-face chromatin and a hof and everything, but others look for all the world like blasts. In the bone marrow aspirate above, you can see tons of malignant plasma cells. ![]() Patients with myeloma have a monoclonal proliferation of plasma cells in the bone marrow, meaning that there are a ton of malignant plasma cells that all originated from the same initial cell. The prognosis is generally not great, but new chemotherapeutic agents seem to hold some promise. Patients present with painful, lytic lesions of the bones, recurrent and persistent infections, weakness, renal failure, and hypercalcemia. It’s a relatively common disorder, accounting for 1% of all malignancies and 10% of all hematologic malignancies in adults. Multiple myeloma is a malignant, clonal disorder of plasma cells that originates in the bone marrow. Here’s a question from Twitter: Can you explain to me what the M protein in multiple myeloma is?Ī. ![]()
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