At the beginning of the disease, symptoms may be absent; patients with multiple myeloma may experience many different signs and symptoms, which can vary greatly from person to person. Signs of the disease include bone pain, susceptibility to infection, severe fatigue, kidney failure, and various general nonspecific symptoms.
When the disease is established, most patients already experience severe pain in the bones affected by multiple myeloma. The most affected areas include the spine, chest, and ribs.
Multiple myeloma symptoms are related to different mechanisms:
- Myeloma cells continue to produce antibodies, as normal plasma cells do, but myeloma cells produce abnormal antibodies that have no defense function like normal antibodies. On the contrary, abnormal antibodies (monoclonal component or CM) accumulate causing problems in many organs, first of all the kidneys, with altered renal function (increased creatinine and azotemia).
- The diseased cells grow in the bone marrow compromising the production of healthy cells to be introduced into the peripheral blood, white blood cells, red blood cells and platelets: the reduction of red blood cells and the hemoglobin they contain (anemia), leads to the appearance of pallor, fatigue, fatigue, breathlessness and need for rest or sleep higher than normal; the reduction of white blood cells (leukopenia) does not involve symptoms, but increases the risk of developing infections, often relapsing and slower to resolve; the symptoms of infections can be general (fever, chills) or specific depending on the organ involved (cough in case of bronchitis or pneumonia, burning urine in case of urinary tract infections, etc.. The reduction of platelets does not involve symptoms until the appearance of hemorrhagic complications; bleeding is more frequently in the gums, nose or skin (from small petechiae to the rarest large hematomas).
- The diseased cells, growing in the bone marrow (contained in the bones), tend to determine bone erosion with the formation of areas of bone destruction (osteolysis) that weaken the bone to the point of determining pathological fractures spontaneous or otherwise from low energy trauma. Symptoms are deep pain, aggravated by movements and functional impotence.
Overall, the disease is able to put in place a great burden of symptoms and a marked functional impairment (especially of motor function), with a serious reduction in quality of life already at the time of diagnosis.
The disease, if not adequately treated, inevitably involves the worsening of organ damage (e.g. progressive renal failure, up to the need for hemodialysis); bone involvement involves multiple fractures extremely risky, especially in case of involvement of vertebrae; the accumulation of the antibody in the blood leads to an increase in blood viscosity up to the appearance of neurological symptoms (confusion, altered state of consciousness, coma); the reduction of immune defenses can lead to the onset of infections even extremely serious (eg. pneumonia); the symptomatic pyatrinopenia can lead to the appearance of major bleeding.
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