MULTIPLE MYELOMA= it is a malignant proliferation of plasma cells derived 4m a single clone.  CLINICAL FEATURES=  1-peak incidence is betn 60 n 70 yrs, n m>f.   2-bone marrow involvement= anemia, leucopenia, thrombocytopenia..2-bone involvement= localised bony swelling over veteberae, skull, sternum, ribs n clavicle.. Bone pain n compresive myelopathy..  3-renal invovlement= nephrocalcinosis, amyloidosis, progressive renal failure.  4-immune system involvement= increased suseptibility to infections,(resp. n urinary tract) 5-hyperviscosity syndrome= blurred vision wid retinal venous congestion, papilloedema, headache, vertigo, nystagmus..6-clotting problems= purpura, epirtaxis, gastrointestinal bleeding..7-neurological manifestations= amyloid peripheral neuropathy, carpal tunnel syndrome, radiculopathy.. INVESTIGATIONS= 1-haemogram..2-peripheral blood smear..3-urea, creatinine, n electrolytes..4-serum calcium..5-serum uric acid level..6-serum alkaline phosphatase..7-serum protein level..8-serum immunoglobulin..9-radiological examination.. 10-electrophoretic studies..
TREATMENT= A) general measures- a)treat infections.. b) give fluid 3 L/day.. c) for copromised renal function give sodium bicarbonate orally..d) allopurinol 300mg/day..e) anagelcis.. B)stem cell transplantation by high dose chemotherapy for meloablation.. C) chemotherapy=   a) combination alkylating agent melphalan and prednisolone in 6 weekly pulses..    b) for cytopeni patients i.v. Cyclophosphamide weekly.. D) Radiotherapy= for pathological fractures, bone pain, tumerous lesion... E)miscellaneous= thalidomide and bortezomib.. 

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