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Myeloma (Pathophysiology/ Symptoms (Hyperviscosity syndrome (血液高度黏稠症候群)…

- - - - 變矮
    - - expanding costal lesions
      - soft tissue masses
  - - - Streptococcus pneumoniae
      - gram-negative organisms
    - - immune dysfunction
        
        impaired lymphocyte function
        
        suppression of normal plasma cell function
        
        hypogammaglobulinemia
      - physical factors
        
        hypoventilation
        
        rib cage and spine
        
        pathologic fractures
        
        pain
  - - - paravertebral plasmacytoma
      - collapsed bone (rare)
    - - 造成半身麻痺或無法控制尿液、大便之排泄
      - thoracic or lumbosacral area
    - - Cord compression
        
        原因
        
        extramedullary plasmacytoma
        
        bone fragment due to fracture of a vertebral body (5%)
        
        症狀
        
        severe back pain
        
        weakness or paresthesias of the lower extremities
        
        bladder or bowel dysfunction or incontinence
        
        medical emergency
        
        避免 permanent paraplegia
      - Peripheral neuropathy
        
        原因
        
        amyloidosis
        
        POEMS syndrome (osteosclerotic myeloma)
        
        polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes
        
        paraneoplastic mechanism
      - CNS involvement
        
        原因
        
        Intracranial plasmacytomas
        
        myelomatous lesions of the skull
        
        plasmacytomas involving the clivus or base of the skull
        
        Leptomeningeal myelomatosis
        
        hyperviscosity or high blood levels of ammonia
        
        Rare
        Myeloma cell lines 產生ammonia
  - - - 眩暈、嗜睡、末梢神經症狀、痙攣
    - - 易疲勞、全身無力、食慾不振、體重減輕
    - - 視網膜出血、視乳突的水腫等，造成視力障礙
  - - - 鈣當作 unmeasured cation
      - cationic IgG molecule
    - - binding of the monoclonal protein with calcium
      - Bone lesion (osteolytic)
  - - - bone marrow replacement
      - kidney damage
      - dilution in the case of a large M-protein
  - - - light chain cast nephropathy
        (myeloma kidney)
        
        high involved free light chain (FLC) levels (>1500 mg/L)
        
        Bence-Jones 蛋白 (輕鍊: ϰ 或 λ)
        沈積於腎小管 (distal convoluted tubule + collecting duct)
        形成 tubular (myeloma) cast
      - hypercalcemia
      - 其他:
        concurrent light chain (AL) amyloidosis,
        light chain deposition disease,
        drug-induced renal damage
  - - - large, purplish, subcutaneous masses