Monoclonal antibodies (m-proteins) monoclonal gammopathies of unknown significance (mgus) general characteristics general clinical features specific associated clinical syndromes testing neoplastic & systemic disorders cryoglobulinemia igg & iga mgus multiple myeloma osteosclerotic myeloma waldenström's macroglobulinemia monoclonal gammopathies of unknown significance (mgus) general characteristics types of light chain: k > l quantity: < 3 g/dl urine monoclonal: rare marrow plasma cells: < 5% skeletal lesions (x-ray): absent cbc: normal organomegaly: none immunoglobulin (ig) heavy chain class patient group (%) igg igm iga igd biclonal light chain all m-proteins 60 20 10 < 1 3 7 polyneuropathy & mgus 35 50 12 3 testing for m-protein: serum & urine optimal clinical method: immunofixation quantitative immunoglobulin: < 3 g/dl? buy viagra without prescriptions viagra no prescription review viagra without a doctor prescription not scam cheap viagra 150 mg Can you buy viagra canada 24 hour urine for bence-jones protein after m-protein found x-ray skeletal survey detects both lytic & blastic lesions antigen target of igm m-protein cryoglobulins bone marrow biopsy indications very elevated immunoglobulin class of m-protein low level of other immunoglobulin class abnormal skeletal survey normal: < 5% plasma cells in bone marrow general clinical features associated systemic disorders: 35% neoplasms 26%: may occur at time of dx or during follow-up myeloma 14% lytic osteosclerotic lymphoma 5% plasmacytoma 4% chronic lymphocytic leukemia 3% waldenström's macroglobulinemia 2% amyloidosis 9%: often with myeloma no associated systemic disorders: 65% monoclonal gammopathy of unknown significance (mgus) light chain: kappa more often than lambda normals: mgus occur more commonly with increasing age 1% to 1. young people taking viagra recreationally buy viagra online no prescription viagra online without prescription usa viagra 1st time viagra without doctor prescription 7% of patients > 50 years 3% of patients > 70 years neuropathy occurs in 5% of mgus igm mgus most common specific syndromes associated with igm binding to neural antigens 50% have anti-mag binding treatment of neuropathy: general principles depends on clinical syndrome & underlying disorder sensory symptoms treated symptomatically unless disabling igg & iga mgus more responsive to plasma exchange than igm cidp treated with same regimen as idiopathic disease c. viagra in canada without prescription Female viagra newsweek viagra cost in australia order viagra no prescription viagra no prescription review buy viagra online usa no prescription is viagra ever covered by insurance buy viagra on line without prescription viagra no prescription review My two passions are travel and photography & I indulge them shamelessly.

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