ISSUE13

ISSUEMay
2021

This issue
Last Month’s Slides P.1
Monthly Case study P.1
Multiple Myeloma P.2
Multiple Myeloma P.3
Blood Cancer Day P.3

Last Month’sSlides
April 2021 Slide
Summaries

Side 1
Acute Myeloid Leukaemia (AML)

Slide 2
Acute Myeloid Leukaemia (AML)

Slide 3Hyper-granulated PMN,
thrombocytosis

Slide 4
Nothing abnormal detected

Slide 5
Nothing abnormal detected

Slide 6

Monthly Digital Case study
April - Slide 1
Presentation
Male, 74 years old

FBC Results
WBC
RBC
HGBHCTMCVMCH
MCMH
PLT

12.2 (10^3/mm3)
3.00* (10^6/mm3)
9.0* (g/dL)
25.1* (%)
84 (fL)30 (pg)35.7* (g/dL)
10* (10^3/mm3)

Blast

Erythroblast

Neutrophils 46.5%
Lymphocytes 24.4%
Monocytes 10.5%
Eosinophils 0.0
Basophils
0,0
Abnormal Leucocytes 16.7%

Nothing abnormal detected

Slide review

Metamyelocyte

Oncology consultation. Bicytopenia.
Blastosis. Thrombocytopenia. To be compared with
oncological assessment. Expert comments: Aspect thatshould be investigated for AML. Probably secondary AML.
Presence of promonocytes to be considered as blasts.

Blood cancerThe three main groups of bloodcancer are:• Leukaemia• Multiple myeloma (see right)• Malignant Lymphoma(cancer of the lymp nodes).
For patients diagnosed with
one of these blood cancers, ablood stem cell donation given
by a close matching donor
offers the best chance ofsurvival.

Multiple Myeloma
Multiple Myeloma or Myeloma is a cancer caused by the abnormal
proliferation of Plasma Cells within the bone marrow. The term multiple isused as it affects multiple parts of the body. Myeloma is the 14th mostcommon of all cancers. In 2020 there were approximately 176.000 newcases (1) and caused 120.000 deaths worldwide. Myeloma is morecommonly diagnosed in the over 65s, however, it has been diagnosed inyounger patients, it is more common in males than females and is twice ascommon among individuals of African origin than Caucasian origin.
Prolonged exposure to petrochemicals, agricultural chemicals and radiation
is known to be a risk factor. Abnormal plasma cells release large amounts ofabnormal monoclonal immunoglobulin (Paraprotein), which can bedetected in the blood and urine of myeloma patients. Immunoglobulins are
the antibodies produced by the immune response to help fight infection.
There are 5 main types of Immunoglobulin: IgG, IgA, IgE, IgM, IgD and allcontain two identical heavy chains and two identical light chains. The
antigen binding site is the variable region on the heavy and light chain.

Key facts (2):• Every 35 seconds someone
is diagnosed with bloodcancer• 4 out of 10 people in need ofa blood stem cell donationworldwide are still unable tofind a matching donor• Every year, over 80,000
people in need of a blood
stem cell donation search
globally for a matchingdonor outside of theirfamily.

To find out more about theWorld Blood Cancer Day, seepage 3.

Myeloma can best be classified according to the type of abnormal
Immunoglobulin (Antibody) produced (IgG, IgA, IgD, IgM, IgE) which can befurther subdivided by the type of light chain (kappa or lambda). IgG kappa is
the most common type of Myeloma. IgA myeloma can sometimes be
associated with extramedullary plasmacytoma – myeloma deposits outsideof the bone marrow. IgD myeloma is associated with Plasma Cell leukaemia(>20% Plasma Cells). In approximately 20% of myeloma patients only lightchains (not the full Immunoglobulin) are produced and are known as freelight chains or Bence Jones Proteins. As the plasma cells increase in numbers
they crowd out the normal haematopoietic tissue in the marrow causinganaemia, excessive bleeding and reduced inability to fight infection.
Myeloma causes structural bone changes, leading to bone pain andpotential fractures.
Symptoms of Myeloma: Bone pain, especially in spine or chest, nausea,constipation, loss of appetite, fatigue, frequent infections and weight loss.
Laboratory findings in Myeloma patients:
FBC
Low Hb, Platelets, WBC, raised ESR
Blood film: The blood film may show RBC rouleaux formation where the redcells appear to stack together like a stack of coins, caused by the increase inplasma proteins.

QSP 2.0
Available as a single
use license and asite/network license
which allows up to50 concurrent users.
To find out more,contact us.

Rouleaux formation

Plasma CellBibliography

The space between the cells may show a blue background stain due again to
the increased concentration of plasma proteins.

(1) Internationalagency for research
on Cancer (WHO)

Plasma cells may be seen and are characterised by their dark blue cytoplasm
and the nucleus being on one side of the cell.

(2) World BloodCancer Day

Bone Marrow: Bone marrow aspirate and biopsy are essential in evaluating,
if abnormal cells are present and if present, evaluating the degree of bonemarrow involvement. Genetic analysis can also be performed, as geneticsubtypes have important prognostic value.

(3) Myeloma UK

Other blood tests: Protein electrophoresis and immunofixation to detect andidentify the amount and type of monoclonal immunoglobulin (paraprotein)present, Serum free light chains assay is performed to measure the kappa lambda ratio. Other tests include Creatinine, Albumin, Calcium, Total Protein
to assess kidney and liver function.

Editorial Team
Kelly Duffy
Andrew Fisher

Beta 2 Microglobulin (B2M): this protein is increased in myeloma patientsand is one of the most important indicators of both the amount and activityof myeloma. The B2M level is used in the staging of patients.
Treatment: If treatment is deemed necessary, then combination therapy
using 3 anti-myeloma drugs which usually consist of a chemotherapy drug, asteroid (dexamethasone, prednisolone) and another drug, such as
thalidomide, bortezomib and lenalidomide. Intensive therapy may also begiven e.g. high dose therapy and stem cell transplantation (3).

WORLD BLOOD CANCER DAY
28th May marks the World Blood Cancer Day, which was established in 2014
to raise awareness about blood cancer.

About us
HORIBA UK Limited
Kyoto Close
Moulton Park
Northampton, UK
NN3 6FLHORIBA Medical
Parc Euromédecine,
390 Rue du Caducée,
34790, France
www.horiba.com/medical

HORIBA joins people around the world showing their support for people withblood cancer and remains committed to raise awareness of these complex
diseases and increase the understanding of the different types of bloodcancer, their symptoms, and types of diagnosis and treatment available.