What is multiple myeloma? | Hematologic System Diseases | NCLEX-RN | Khan Academy
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What is multiple myeloma? | Hematologic System Diseases | NCLEX-RN | Khan Academy


– [Voiceover] Alright, so let’s
talk about Multiple Myeloma. And I’d like to start by
introducing you to Babs. And Babs is a 70-year-old lady and over the past few months she’s been becoming really crabby. And she has all sorts of complaints. And so, because of this, I’m going to call her “Babs the Crab.” So, what are some of the complaints that Babs has been experiencing? Well, first, she’s been
having some GI symptoms, things like constipation,
nausea, and a poor appetite. And I’ll just represent that here. She also has been drinking
a lot more than normal, and frequently complains of being thirsty. She’s also been more tired than normal and some of her family
members have noticed that her skin’s been
maybe just a little bit more pale than it usually is. So, I’m just going to write that in here as “fatigue” and “pallor,”
and then we can kinda make her skin look a
little bit more pale here. And lastly, she’s been complaining of this just constant, dull lower back pain. Now, although each one
of Babs complaints here are in themselves fairly
non-specific and vague, when you take them as a whole, they are actually fairly telling. And an astute medical provider
would likely be concerned that she may have Multiple Myeloma. Now before I talk about
why these symptoms here are consistent with Multiple Myeloma, let’s first just answer the question, “What is Multiple Myeloma?” And Multiple Myeloma is a malignancy or a cancer of plasma cells. And I’m going to just also star this here, because it’s very important. Well, what are plasma cells? Well, plasma cells are
a type of blood cell that produce antibodies and antibodies are part
of the immune system and they help our bodies fight infection. And there are four major
mechanisms of Multiple Myeloma that I want to address here. And this first mechanism
is a monoclonal production of immunoglobulins or antibodies. And I’m just going to
abbreviate immunoglobulins, Ig. Well, what do I mean by this? Well, when you have a
malignancy of a plasma cell, that malignancy actually
starts in just a single cell and that single cell replicates
over, and over, and over. So what you get is this
increased production of only the type of antibody that that original cell produces. And, these immunoglobulins
are actually proteins, and the proteins, can
precipitate and deposit in different areas of the kidney. And this results in renal
failure, or kidney failure. The next mechanism is an
increased bone turn-over. So these malignant plasma
cells release certain factors into the blood that affect the bone, and they cause the bone to turn-over, to break-down in a sense, and
this increased bone turn-over results in what are known
as lytic bone lesions. And they predispose the bone to fractures. By this I mean they make the
bone more likely to break. And the most likely
site of these fractures is in the spinal column. And as the bone is being turned
over and being broken down, it’s also releasing calcium. So this results in hypercalcemia. The next mechanism is
crowding of the bone marrow. Now, before I describe this mechanism, I want to briefly go
over what bone marrow is. So let me just draw a bone here. So bone marrow is in the center of bones and it’s where blood cells are produced. And so, let’s just draw
in some blood cells here. So maybe some of the cells
that produce red blood cells, and some of the cells
that produce platelets, and then some of the cells that
would produce plasma cells. So this would be a normal bone marrow, producing the different
types of blood cells. But, when you have a malignancy
of these plasma cells, the one type of plasma cell
is just growing uncontrollably and you get this crowding
out of the bone marrow by only the plasma
cells, so the bone marrow is no longer producing enough
red blood cells or platelets. And so, this results in
anemia and thrombocytopenia. And anemia refers to a low level of red blood cells in the blood, and thrombocytopenia refers to a low level of platelets in the blood. And the last mechanism
is a decreased production of normal immunoglobulins, so once again I’ll abbreviate that Ig,
which are antibodies. And, if the body isn’t able
to produce normal antibodies, then the body is not able to adequately fight off infections. So individuals with Multiple Myeloma have an increased risk of infection. So you can see that some
of these colors here in the different mechanisms
of Multiple Myeloma correlate with the
symptoms that Babs the Crab was experiencing, and
that isn’t a coincidence. And I’m going to start here
with the hypercalcemia. And when someone has hypercalcemia, they will oftentimes
experience certain GI symptoms such as constipation,
nausea, and a poor appetite. You can remember this with this C here, and then I’ll highlight
the C over here in Crab. And then the next one
is this renal failure, and when someone has renal failure, sometimes their kidneys
won’t be able to retain water so the individual will
become very thirsty. And so that’s why Babs here
had this increased thirst, cause she was having renal failure. And so we’ll just highlight
the R here in renal failure, and then the R over here
in CRAB for renal failure. The next is the anemia, so
what anemia means is you have a decreased amount of red blood cells. And red blood cells
carry oxygen to the body. So, if you don’t have
enough red blood cells, your body can’t get enough oxygen and so the body becomes fatigued. The skin also becomes pale, so you have this fatigue and pallor due to the anemia. And so for A for anemia
we’ll just highlight the A in CRAB over here. And then lastly, you have
these lytic bone lesions that have an increased risk of fractures. And so frequently people
with Multiple Myeloma will have this low back pain. And we’ll highlight the B there for bone or back, and
that is the B in CRAB. So the reason that Babs
the CRAB was all crabby is because CRAB is actually
just an acronym to help you remember what is happening
in Multiple Myeloma. Someone who has Multiple
Myeloma will experience hypercalcemia, renal failure, anemia, and bone lesions that cause back pain. Alright, so how do you
diagnose Multiple Myeloma? Well you can really just follow through each of these categories
to help get an idea. So with the renal failure, you can check certain blood levels,
like BUN and Creatinine which can show signs of renal failure. And then you can also do a test called an Electrophoresis,
and what this is is a special test that detects
this monoclonal production of IgG and it can be done on
either the serum or the urine, and the result it has
is known as an M spike. And this is a little bit
confusing, and I don’t want to get into all the
nitty-gritty details of it, but just remember that
electrophoresis will detect this monoclonal production of Ig. And then, for the lytic bone lesions, to diagnose that, you can do a bone scan. Hypercalcemia is just
detected in the blood. For the anemia and thrombocytopenia, the diagnosis can be through
a complete blood count. Which will show a decreased
red blood cell count and decreased platelet
count, or you can see this crowding of the bone marrow on a bone marrow biopsy. So these are the tests that you would do to diagnose Multiple Myeloma. Now I’m going to just briefly address the treatment of Multple Myeloma. Now, like many areas of cancer treatment, the specific methods for
treating Multiple Myeloma rapidly change, so I’m
not going to address any specific medications that are used, but just talk about a general approach to treating Multiple Myeloma. And there is two general approaches. The first approach is to treat
the symptoms of the disease, and cause disease regression. And this is accomplished
through different medicines as well as chemotherapy. And then the other approach for treatment of Multiple Myeloma is curative. And this is achieved through
a bone marrow transplant. I’ll just abbreviate that BMT. And so obviously when you have a cancer, the goal is to cure the individual; however, bone marrow
transplants can be very hard on people, and since Multiple
Myeloma like in Babs here is most common in the elderly with a median age right
around 70 years old, oftentimes bone marrow transplants aren’t able to be performed
because the patient just would not handle the treatment very well. And so, the mainstay of
treatment are certain medications as well as chemotherapy. So just remember that Multiple Myeloma is a malignancy or a
cancer of plasma cells, and that CRAB is an
acronym for the effects of Multiple Myeloma, with C
representing hypercalcemia, R for renal failure, A for anemia, and B for the lytic bone
lesions and low back pain.

About James Carlton

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32 thoughts on “What is multiple myeloma? | Hematologic System Diseases | NCLEX-RN | Khan Academy

  1. why this disease is called Multiple myloma, although this is a disease of plasma cell which is derive from B-lymphocytes.

  2. Question ? now that we understand the scientific explanation of what it is does anybody know the root cause or deficiency that creates this condition? My father has a form of this and I'm trying to help him Address the root cause so he does not have to take a bunch of drugs…. thank you very much if anybody can help me.

  3. U explained this like woww….. Awsme i love khan academy….and ur voice is soo soothing to my ears😍😍😍😍😘😘😘

  4. Thank you very much. Can a doctor be able to change good results of tests results, just to be able to charge 💰 to insurances? Please, I need help. I think doctor fix results so the can colet 💰. Sorry

  5. I am 65 years old and my MM was detected on September 2016.Useful information.I had gathered this information from multiple myeloma research foundation.in my case the autologous stem cell transplant did last for 60 days only.
    I have multiple bone lyric lesions with 9 fractured vertebrae and three fractured ribs.
    Undergoing Maintenance Bortezomib chemotherapy every 14 days since past 10 months.Cytogenetic FISH report and bone biopsy shows VGPR.I have 3 clinal damages t(4,14),1q amplification and hyper diploids.

    Three fellow MM patients in age groups of 53,59 & 66 years died in last 3months two years after autologous stem cell transplant.
    May beI am next in line as my stem transplant was done 18 months ago.

  6. I think – paraprotein production leading to acute kidney injury. Thirst follows polyuria induced by hypercalcaemia (through osmotic effect and ADH desensitisation). Thirst isn't a feature necessarily of AKI.

  7. This is a wonderful depiction and explanation. However, it is not a disease that only affects the aged. It affects many younger people. http://give.myeloma.org/hayshike19 It is showing up more in and more in people that are not elderly.

  8. I have been fighting for 6 years and today i feel like crap.
    What diet do we do?
    My protein numbers are extremely high.

  9. Thankyou for such a beautiful explanation.
    This is my topic for presentation. Fell in love with the topic after viewing your video.

  10. let me introduce you to Multiple Myeloma ,, it stole my husband,,, its a NASTY, disgusting. relentless cancer, robbery of your physical and mental state. Graduation from canes, to rolling walkers, to wheelchairs. Endless concoctions of trial and error chemos, bone treatments, radiation, stem cell transplantation, lytic lesions GALORE,,,,, let me introduce you to one of the most horrifying incurable cancers out there!!!!!!!!!!! lived it for seven very very long years !!! last straw to save my husband's life, 6 round chemo at THE SAME TIME WHILE THE MED TEAM PERFORMING THE PROCEDURE WEARS HAZMAT SUITS!!!!! YOU GOT TO BE FU****ng KIDDING me,,, we gave up RIP MY LOVE 12/13/62,,, 06/16/17,,, YES MULTIPLE MYELOMA performed its final nasty deed on Fathers Day,,, my husband passed away on fathers day,,, let me tell you about Multiple Myeloma

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