Mieloma Múltiplo

Summary

This presentation provides a comprehensive overview of multiple myeloma, focusing on its diagnosis, treatment, and management of pathological fractures. It highlights the importance of early diagnosis using key markers like beta-2 microglobulin, the significance of preventing fractures, and the potential for healing without surgery. The speaker emphasizes the role of prophylactic fixation and the importance of monitoring the disease’s progression. The session is especially valuable for medical professionals, offering insights into practical management and preparatory tips for exams in orthopedics.

Takeaways

• 😀 Multiple myeloma (mieloma múltiplo) can cause pathological fractures, significantly affecting patient mobility and increasing the risk of mortality.
• 😀 Preventing pathological fractures in multiple myeloma patients is crucial, as these fractures can severely restrict daily activities and lead to more complications.
• 😀 The consolidation potential of fractures in multiple myeloma patients is high, with healing rates exceeding 60%, especially when compared to cancers like lung cancer.
• 😀 In cases of multiple myeloma, fractures can heal without surgical intervention, especially when treated effectively with chemotherapy.
• 😀 Staging of multiple myeloma involves monitoring beta-2 microglobulin levels, which serve as a key prognostic factor for patient survival.
• 😀 High levels of beta-2 microglobulin correlate with lower survival rates in multiple myeloma patients.
• 😀 The diagnosis of multiple myeloma involves identifying lytic bone lesions, monoclonal protein peaks, and bone marrow plasmocytosis greater than 10%.
• 😀 Bone destruction in multiple myeloma is indirectly mediated by osteoclasts, rather than by direct tumor invasion.
• 😀 Bone marrow biopsy should not be performed before electrophoresis of proteins, as altered results may require further bone marrow examination.
• 😀 Preventing fractures through prophylactic fixation of lesions can provide significant benefits to multiple myeloma patients, improving quality of life and survival outcomes.

Q & A

What is the primary concern with pathological fractures in multiple myeloma?

The primary concern with pathological fractures in multiple myeloma is that they significantly impair the patient's mobility, increase pain, restrict daily activities, and most importantly, increase the risk of mortality.

How does the healing potential of fractures in multiple myeloma compare to other cancers?

The healing potential for fractures in multiple myeloma is relatively high, with a healing rate exceeding 60%, which is notably higher than for fractures caused by cancers like kidney, breast, and lung cancers, where the healing potential is much lower.

Why was surgery not necessary for the patient discussed in the lecture despite having a pathological fracture?

Surgery was not necessary because the patient responded well to chemotherapy, allowing the fracture to heal without surgical intervention, particularly since the lesion was located in the upper limb.

What is the role of beta-2 microglobulin in the diagnosis and prognosis of multiple myeloma?

Beta-2 microglobulin levels are a key factor in diagnosing and staging multiple myeloma. Increased levels are associated with a worse prognosis, as they correlate with reduced survival rates for patients.

How does the destruction of bone in multiple myeloma occur?

In multiple myeloma, bone destruction is mediated indirectly through the activation of osteoclasts, which are cells that break down bone tissue.

Why is protein electrophoresis important before performing a biopsy on a bone lesion in multiple myeloma?

Protein electrophoresis should be conducted before performing a biopsy on a bone lesion because abnormal results may indicate the need for a bone marrow biopsy for a more accurate diagnosis.

What are the diagnostic criteria for multiple myeloma?

The diagnostic criteria for multiple myeloma include the presence of lytic bone lesions, monoclonal protein peaks in electrophoresis, and more than 10% plasma cell involvement in the bone marrow.

What is the relationship between age and the incidence of multiple myeloma?

Multiple myeloma is most commonly diagnosed in older adults, with the frequency increasing as age advances.

How can prophylactic fixation help in managing multiple myeloma fractures?

Prophylactic fixation of bone lesions can prevent fractures by stabilizing the bones, reducing the likelihood of fractures and improving overall patient outcomes.

What does the lecturer suggest about the importance of preventing fractures in multiple myeloma patients?

The lecturer emphasizes that preventing fractures is crucial because they can severely affect the patient's quality of life, leading to more complications and an increased risk of death. Prophylactic measures like fixation are vital for improving patient prognosis.