Revision as of 06:03, 14 January 2023

Multiple Myeloma

H&P: Often presents with CRAB symptoms (Calcium, Renal failure, Anemia, or Bone lesions) or frequent infections. Can be complicated by unstable bradycardia, osteoporosis, ATN (via IG light chain, an endogenous nephrotoxin), nephrotic syndrome secondary to renal (AL) amyloidosis, type II RTA
Dx: Bone marrow biopsy showing >10% clonal plasma cells + end organ damage (CRAB) OR >60% clonal plasma cells without end organ damage. M-spike on SPEP (also shows up in smoldering myeloma). Bone scan shows punched out lesions. Hyperviscosity syndrome when there is monoclonal IgM, this leads to impaired platelet function and epistaxis/gingival bleeding (overall more common in Waldenstrom's macroglobulinemia). β2 microglobulin is a prognostic marker.
Tx: Autologous Stem Cell Transplant or chemotherapy

For supratherapeutic INR in a patient on Warfarin, if INR <4.5, can hold Warfarin for 1-2 days then recheck and resume, if INR 4.5-10, give 1-2.5 mg PO vitamin K.
The biggest drawback of IVC filters is that they double the risk of DVT
Factor V Leiden accounts for about 50% of hereditary thrombophilia.
Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
Treatment for HIT is discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to depletion of protein of C)

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 *Factor V Leiden accounts for about 50% of hereditary thrombophilia.
 *Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
+*Treatment for HIT is discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C''')