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Beta 2 Microglobulin Test

Beta 2-microglobulin test, also known as the B2M test is an effective tumor marking diagnostic investigation. Beta 2 Microglobulin is a protein that is found in the cell membrane. Beta 2 Microglobulin predominantly associates with heavy chains of the immunoglobulin belonging to the major histocompatibility (condition in which the cells of one tissue can survive in the presence of cells of another tissue) cells of class I origin. The class I antigens are expressed in the lymphoid cells. Hence these antigens are called classic transplantation antigens. Beta 2 microglobulins are remarkable with respect to initiating cellular immunity. Their small size (11,500 Daltons) allows them to pass through the glomerulus during the process of renal filtration.


Clinical manifestations associated with the beta 2-microglobulin factors are predominantly associated with vital organ functionalities. It also paves the way to analyze the presence of tumors especially in case of myelomas. It is also used as an effective prognostic marker in case of malignancies such as leukemia. Raised beta microglobulin levels indicate the presence of disorders pertaining to kidneys, which is a primary indication of renal failure. The reference range in case of serum is microgram/ ml and in case of urine specimen, it is 0.3 microgram per ml. Many oncologists prefer to request the B2M test in order to rule out the severity of metastases in case of conditions like multiple myeloma.


Central nervous system involvement can also be analyzed by estimating the B2M values. In multiple myelomas, the proliferation of B2M occurs at a minimum level at the first stage, and as the stage proceeds the serum values of the B2M values rise to a larger extent. This indicates the body's inability to identify the foreign cells leading to immune system associated cellular disorders like cancers. The class I antigens which serve as the surface recognition cells help in identifying the foreign cells and the B2M test is very essential.


Clinical studies on this respective protein affirms its importance as independent predictor of the asymptomatic multiple myeloma. B2M investigations along with other indicators can be an effective prognostic tool in identifying and diagnosing multiple myelomas of different kinds. With respect to central nervous system involvement, elevated cerebrospinal fluid also indicates rise in B2M values. In addition to these classical conditions, B2M values are elevated in autoimmune disorders and viral infections especially in Cytomegalo virus.


The significance of B2M analysis

Malignancy: Indicator for the onset of chronic lymphocytic leukemia and multiple myeloma.

Waldenstorm macroglobulinemia: In this condition the B2M is an effective indicator to rule out the presence of myeloid-dysplastic syndromes.

HIV:Inverse correlations of B2M are significant in relation with CD4+ T-lymphocyte cells indicating disease progression.

Neurological involvement: In conditions such as sarcoidosis, dementia and meningitis, elevated CSF and B2M levels are significant markers.

Rheumatologic involvement: Studies indicate the presence of B2M deposits in higher amounts in the joints indicate rheumatologic association of the respective protein molecule.


Thalidomide

Certain skin conditions like Multiple Myeloma (a type of Cancer due to abnormal plasma cells), Hansen's disease (Leprosy) can be treated or the symptoms mitigated using thalidomide. It reduces redness and inflammation in Hansen's disease. It reduces the formation of blood vessels that feed tumors and thus is used extensively in cancer treatment. Thalidomide is an immunomodulatory agent. It works on the immune system to decrease certain substances that cause skin inflammation. Thalidomide is also prescribed for treatment of Sarcoidosis, HIV and Crohn's disease.


Thalidomide as a drug was primarily developed and used as a sedative to treat insomnia, anxiety and tension. The drug is also known as Asmaval, Valgis, Tensival, Distaval Forte and Valgraine. The drug that was popular as a wonder drug was banned in the early 1960s as it was found to cause deformity in children born to mothers who consumed this drug. Thalidomide caused severe to life threatening birth defects when either the father or mother consumed it during the time of fetal conception. Studies prove that this drug did cause birth defects in body parts like the eyes, face, heart, legs, bones and ears. Thalidomide blocked the formation of blood vessels thereby limiting blood flow and creating limbless babies.


In the 1970s thalidomide was used to treat leprosy. Later it was used as an anti-angiogenic - to stop the formation of new blood vessels. The same property of the drug which caused birth defects actually played a vital role in shrinking tumors. Thalidomide is used to treat cancer as it:


  • Can block blood vessels and limit blood flow.
  • Stop growth of blood vessels that can feed cancerous growth in the body.
  • Stabilize blood flow around the site of the tumor.
  • Once blood flow is stabilized around the tumor affected area, treatments like chemotherapy reach more effectively to the affected area.
  • Thalidomide also plays a role in preventing cancer from recurring, post chemotherapy.

Using Thalidomide

This medication should be taken orally. It is usually taken at bedtime, an hour after taking a meal. Handle the capsules with care; do not take them out of the blister pack if not being used immediately. Do not break the capsule. In case of skin contact with the powder, wash the area with soap and water. Hands should be washed thoroughly after handling the drug.

Pregnant women should not consume this drug. Doctors provide dosage based on the prevailing conditions, dosage should not be increased or decreased by the patient. Increase in dosage can cause serious side effects. Do not donate blood or sperm while on this drug. Avoid sexual contact while on this drug as the semen carries the drug in it. To get the maximum benefit of this drug, it has to be used regularly and should not be stopped suddenly. Stopping intake of the drug suddenly may worsen the condition.

While on this drug, make sure that your blood does not come in contact with any other person's blood. Thalidomide can make a person feel sleepy; hence alcohol should not be consumed while on this drug.


Thalidomide side effects

Side effects may vary from person to person. Common side effects include dizziness, chest pain, risk of blood clots, general weakness, racing heartbeat, dry skin, seizures and muscle cramps. Nerve damage may cause permanent damage in a few cases. Rare side effects include blood in urine, low blood pressure, reduced urination and fever without rash.



Vertebral Compression Fracture

Vertebral compression fracture occurs when a part in the vertebra collapses due to the compression of the bone in the spine. With age, vertebrae is weakened and loses its strength and leads to a condition called osteoporosis. Osteoporosis is a kind of bone loss that causes bones to break easily. Osteoporosis is the leading cause of vertebral compression fractures especially in the age group of 40 to 50 and above. Post menopausal women and men above the age of 65 years are at highest risk of suffering from vertebral compression fractures.


Apart from osteoporosis, there could be other reasons that lead to vertebral compression fractures. Young adults suffer from vertebral fractures due to spinal injuries during rigorous exercises, sports activities or accidents. These compression fractures normally heal within 8 to 10 weeks with good rest and pain medication. Vertebral compression fractures may also be attributed to cancer tumors associated with multiple myeloma and metastatic bone disease. In very rare cases, infection or Osteomyelitis of the vertebra also results in compression fractures.


Wedge fractures are the most common type of compression fractures wherein the front part of the vertebral body collapses and becomes wedge shaped. Other types of vertebral compression fractures include biconcave (collapse of central portion of vertebral body) crush fractures (collapse of entire vertebral body). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).


Symptoms of Vertebral compression fracture

Compression fractures caused by injuries produce sudden onset of sharp and throbbing pain. Fractures caused by osteoporosis may cause very mild to severe pain in the back. Normally the pain is intense in standing posture and there is respite when lying down.

Vertebral compression fractures also lead to kyphosis and loss of height especially with the fractures associated with osteoporosis.

Sometimes a severely fractured bone can impinge on the spinal cord. Thus, numbness or tingling in limbs or other areas of the body may occur if the spinal cord is affected. This can impair sensation in the areas supplied by the damaged nerve tissue.


Diagnosis

Doctor's evaluation of symptoms plays a major role in diagnosing compression fractures. Noting of complete history of the patient and clinical examination are necessary to determine the presence of vertebral compression fracture. When doctor suspects vertebral compression fracture, an x ray is ordered to confirm the diagnosis. If the X-Ray reveals a fracture, further imaging tests like CT scan and MRI are performed to rule out the involvement of spinal cord and also to understand the age of the fracture. A neurological exam may also be done to test for reflexes, muscle strength and sensory perception.


Treating Vertebral Compression Fracture

The conventional methods of treating vertebral compression fractures include pain medication, rest and bracing. While pain medication helps in alleviating the pain to some extent, back braces reduce the chance of further collapse of the bone, prevent deformity, and allow injuries to heal by taking the pressure off the fractured vertebral bone. Giving rest to the back by decreasing activities as much as possible helps in healing the fractures naturally and quickly.


There are also some minimally invasive methods used to treat vertebral fractures which are gaining popularity. Vertebroplasty and Kyphoplasty are two medical procedures that are increasingly being used to treat compression fractures. Here the fracture is treated by injecting a bone cement onto the collapsed bone through hollow needle. These are image-guided surgical procedures with minimum invasion that promise faster pain relief.


Further treatment also depends upon the underlying cause that is leading to vertebral fracture. If the osteoporosis is causing the bones to collapse, doctor may prescribe calcium and other bone strengthening supplements to avoid future compression fractures. If a tumor has caused compression fracture, more invasive surgery will be required remove sections of bone or tissue.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 17, 2019