Question

A oil-rig worker was noticing that he had been becoming more and more easily fatigued and complained of "aching in his bones" and urine that "turned white (precipitated-out) when he urinated. He slipped climbing a ladder and fractured his femur and was immediately flown to the nearest hospital. Upon admission, the physician set his leg and upon examination noticed that the patient was anemic, pale and weak for a person in his line of work. Blood, urine and a bone marrow aspirate samples were obtained for analysis and demonstrated the following:

Hematocrit--low; bone marrow--increased numbers of plasma cells and large multi-nucleated cells; serum immunoglobulins IgG 2100 mg% (Normal 600-1500mg%); IgA 200 mg% (normal 50-125 mg%); IgM 50 mg% (Normal 75-150mg%); Urine-Proteinuria.

These data, along with corroborating radiological and histological findings yielded the diagnosis of Multiple Myeloma. Based on this information, please account for the proteinuria condition; and, fully-describe what these proteins are as well as their relationship to the condition diagnosed in the patient.

Answer 1

A multiple myeloma is caused by abnormal neoplastic plasmatic cells, they’re a type of white blood cell. Normal plasma cells make antibodies to help the body fight infections and diseases, hence when plasma cells become cancerous, they divide without control and these retain the capacity to produce antibodies, therefore, with many cancer plasma cells the number of antibodies is increased. However, because neoplastic cells do not function normally and, they produce defective antibodies, which are immunoglobulin-free light chains (called paraproteins) which may be of the kappa or lambda type. This type of immunoglobulins is found in the urine because they are small, and are therefore easily cleared by the kidneys.