CHAPTER 4 Hematologic System^193
- Skeletal fractures due to loss of normal bone structure (osteoporosis)
- Increased risk of infection due to bone marrow failure to produce white
blood cells - Spinal cord compression as mass enlarges
- Renal failure due to protein effect in renal tubules
INTERPRETING TEST RESULTS
- Presence of the Bence Jones protein in urine.
- Serum protein electrophoresis shows a monoclonal protein spike.
- CBC shows anemia.
- Rouleau formation on peripheral smear, a group of RBCs clump together in
a stack (like a stack of coins). - Abnormal plasma cells in bone marrow biopsy.
- X-rays of bone show lytic lesions.
- Elevated calcium in blood (hypercalcemia).
- Protein in urine (proteinuria).
- Elevated erythrocyte sedimentation rate.
TREATMENT
Treatment regimens undergo changes based on patient response and current research
findings. Combination therapy is common in treatment of multiple myeloma.
- Pain management.
- Combination chemotherapy:
- alkylating agent (melphalan) and prednisone
- thalidomide and dexamethasone
- nonalkylating combination (vincristine, doxorubicin, and dexamethasone)
- proteosome inhibitor (borteozomib) and thalidomide derivative (lena-
lidomide)
- Diet high in protein, carbohydrates, vitamins, and minerals.
- Small frequent meals.
- Transfusion of packed RBCs if anemia is severe.
- Bone marrow transplantation.