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  #1  
Old 01-12-2012
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Question IgM spike

A 54-year-old female presents with headaches, visual abnormalities, bleeding, and Raynaud’s phenomenon. Workup reveals a normal serum calcium, and no lytic lesions are found within the skeleton by x-ray. Serum electrophoresis reveals a single large M spike in the peripheral blood due to a monoclonal proliferation of IgM. Sections from the patient’s bone marrow reveal numerous plasma cells, lymphocytes, and plasmacytoid lymphocytes. What is the correct diagnosis for this patient?


A. IgM multiple myeloma
B. Monoclonal gammopathy of undetermined significance
C. µ heavy chain disease
D. Plasmacytoid small cell lymphoma
E. Waldenström’s macroglobulinemia
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Old 01-12-2012
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Is it A) Multiple Myeloma..
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Old 01-12-2012
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E?
Are those symptoms a result of hyperviscosity syndrome?
(the fact that they say they see plasma cells in the bone is tripping me out though)
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Quote:
Originally Posted by khushi.chahal View Post
E?
Are those symptoms a result of hyperviscosity syndrome?
(the fact that they say they see plasma cells in the bone is tripping me out though)
Its either A or B ... large M spike and numerous plasma cells are the clues.

I was thinking B because there are no lytic lesions found but after narrowing it down to A or B, I would go with A. lol
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Quote:
Originally Posted by Hope2Pass View Post
Its either A or B ... large M spike and numerous plasma cells are the clues.

I was thinking B because there are no lytic lesions found but after narrowing it down to A or B, I would go with A. lol
isn't B seen with an IgG spike?
and A seen with IgG and IgA spikes? although they did throw IgM infront of the name so maybe you can just have whatever Ig-type you fancy "-_-
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Quote:
Originally Posted by khushi.chahal View Post
isn't B seen with an IgG spike?
and A seen with IgG and IgA spikes? although they did throw IgM infront of the name so maybe you can just have whatever Ig-type you fancy "-_-
Just checked FA under the Heme section .. Multiple Myeloma is produces large amounts of IgG or IgA. And the "single large M spike" is also present since Multiple Myeloma is characterized by monoclonal Ig spike (M protein on serum protein electrophoresis).

Anyway, yeah the correct answer would be E) Waldenstroms macroglobulinemia .. U get the M spike = IgM which leads to hyperviscosity symptoms with NO lytic lesions.

If the pt is asymptomatic and has the M spike then it would be B)Monoclonal gammopathy of undetermined significance.

Finally got all these cleared up in my head...Always get confused when they throw in the M spike lol
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Old 01-12-2012
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yay i finally got something right!
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Old 01-12-2012
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ans is E
large M spike with monoclonal igM with no lytic lesion is Waldenstrom's macroglobinemia
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Old 01-12-2012
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http://firstaidteam.com/wp-content/u...ata-110817.pdf

guys check the error of first aid the M spike is very non specific .multiple myeloma can even have Igm spike .but more commonly have igA and igG.

its the no lytic lesion that differentiates them

Gluck
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Old 01-13-2012
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answer is E. Multiple myeloma is m-spike (IgG or IgA) plus CRAB...hyperCalcemia, Renal insufficiency, Anemia, Bone lytic lesions... Waldenstrom macroglobulinemia is m spike composed of IgM.
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  #11  
Old 01-13-2012
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B.........
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Old 01-13-2012
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E) I'd go with it. Just was reading about it in Kaplan notes... I think Kaplan made a p. poor job on WBC pathology...

I am sortof confused about them anyway

Was reading your answers and realized that I m not the only confused one.


M spike is not IgM, its just that spike of Albumin and some Antybody

Doest look like "M" in Mcdonald's, but step 1... you know...

IgM spike-spep2.jpg
click image to enlarge
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Old 01-22-2012
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E) CORRECT, Waldenström’s macroglobulinemia (WM), associated with a monoclonal production of IgM, is clinically distinct from multiple myeloma. It is somewhat like a cross between multiple myeloma (MM) and small lymphocytic lymphoma (SLL). As with myeloma, there is a monoclonal production of immunoglobulin (IgM) that produces an M spike. Unlike the case with myeloma, however, there are no lytic bone lesions and no hypercalcemia, and the bone marrow shows proliferation of plasma cells, lymphocytes, and plasmacytoid lymphocytes. Like SLL, WM is associated with infiltration of organs outside of the bone marrow by neoplastic cells. These include the lymph nodes and the spleen. (Involvement of these organs is unusual in patients with MM.) Because IgM is a large molecule (a pentamer), patients with WM are prone to developing the hyperviscosity syndrome, which consists of visual abnormalities, neurologic signs (headaches and confusion), bleeding, and cryoglobulinemia. Other monoclonal proliferations of immunoglobulin include monoclonal gammopathy of undetermined significance (MGUS) and heavy chain disease. MGUS may be associated with an M spike and increased marrow plasma cells, but the number of plasma cells will be less than 20%. Note that M proteins are found in 1 to 3% of asymptomatic persons over the age of 50. Heavy chain disease refers to types of plasma cell dyscrasia that are associated with the monoclonal production of immunoglobulin heavy chains only (not light chains). There are basically three types of heavy chain disease: α heavy chain disease, γ heavy chain disease, and µ heavy chain disease. α heavy chain disease is seen primarily in the Mediterranean region, hence its other name, Mediterranean lymphoma. It is characterized by numerous plasma cells infiltrating the lamina propria of the small intestines. This disease is preceded by an abnormality called immunoproliferative small intestinal disease (IPSID), which is characterized by villous atrophy of the small intestines with steatorrhea. Unique patients with this disease are treated with antibiotics. γ heavy chain disease is rare and is similar to non-Hodgkin’s lymphoma. µ heavy chain disease is found rarely in some patients with CLL
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Old 01-22-2012
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any question with

Ig G spike=== multiple myeloma [dont confuse M type spike.. with Ig M spike)

Ig M spike==== WALDENSTRONG


(given wrong in FA)
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