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{{Waldenström's macroglobulinemia}}
{{Waldenström's macroglobulinemia}}
{{CMG}} {{AE}} {{MGS}}
{{CMG}}; {{AE}} {{S.M.}}, {{RAK}}, {{MGS}}; ; {{GRR}} {{Nat}}


==Overview==
==Overview==
[[M spike]] of IgM type of immunoglobulin is diagnostic of waldenström's macroglobulinemia. <ref name="Lb"> {{cite journal |vauthors=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A, Rodríguez-García JA, Massó P, Pérez-Aliaga A, Monteagudo MD, Navarro I, Moreno G, Toledo C, Alonso A, Besses C, Besalduch J, Jarque I, Salama P, Rivas JA, Navarro B, Bladé J, Miguel JF |title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases |journal=Br. J. Haematol. |volume=115 |issue=3 |pages=575–82 |year=2001 |pmid=11736938 |doi= |url=}}</ref><ref name = qwer> Waldenström macroglobulinaemia. American Cancer Society (2015) http://www.cancer.org/cancer/waldenstrommacroglobulinemia/detailedguide/waldenstrom-macroglobulinemia-diagnosis Accessed on November 15th, 2015 </ref>
[[Laboratory]] findings consistent with the [[diagnosis]] of [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]] include any [[cytopenia]], [[lymphocytosis]], [[monocytosis]], elevated levels of [[Lactate dehydrogenase|LDH]], [[Beta-2 microglobulin]], [[uric acid]], and [[urea]] & [[creatinine]], elevated [[Erythrocyte sedimentation rate|ESR]], [[hypercalcemia]], [[hyponatremia]], positive [[rheumatoid factor]], positive [[cryoglobulins]], positive direct anti-[[globulin]] [[test]], positive [[cold agglutinin titre]], [[proteinuria]], prolonged [[bleeding time]], prolonged [[prothrombin time]], prolonged [[activated partial thromboplastin time]], prolonged [[thrombin time]] and [[peripheral smear]] shows [[plasmacytoid]] [[lymphocytes]], [[Normocytic normochromic anemia|normocytic normochromic red blood cells]] and [[rouleaux formation]].


==Laboratory Findings==
==Laboratory Findings==
 
* WM is mostly suspected when a [[patient]] has low [[blood counts]] and/or high levels of unusual [[protein]] levels on [[blood tests]].
* Usually after that, a [[blood test]] called [[serum protein electrophoresis]] is ordered to find out what type of [[protein]] is there.
* Mostly, only after these [[Test|tests]] are done that a [[biopsy]] of either the [[bone marrow]] or a [[lymph node]] is considered to confirm the WM [[diagnosis]].
*[[Laboratory]] findings consistent with the [[diagnosis]] of [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]] include:<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref>
===Complete blood count===
===Complete blood count===
*[[Normocytic normochromic anemia]]: presents in 80% of patients<ref name="Lb">{{cite journal |vauthors=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A, Rodríguez-García JA, Massó P, Pérez-Aliaga A, Monteagudo MD, Navarro I, Moreno G, Toledo C, Alonso A, Besses C, Besalduch J, Jarque I, Salama P, Rivas JA, Navarro B, Bladé J, Miguel JF |title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases |journal=Br. J. Haematol. |volume=115 |issue=3 |pages=575–82 |year=2001 |pmid=11736938 |doi= |url=}}</ref>
*[[Anemia]]:
*[[Leukopenia]]
**Seen in 40% of [[New|newly]] [[Diagnose|diagnosed]] [[patients]] and in 80% of [[symptomatic]] [[patients]] with [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]]
*[[Thrombocytopenia]]: presents in 50% of patients with bleeding diathesis
**Multi-factorial [[causes]] including: decreased [[RBC]] [[synthesis]] due to [[bone marrow infiltration]], [[iron deficiency]] due to [[gastrointestinal bleeding]], and [[chronic inflammation]]
 
*[[Thrombocytopenia]]:
**Due to [[bone marrow]] [[Infiltration (medical)|infiltration]]
*[[Neutropenia]]:
**Due to [[bone marrow]] [[Infiltration (medical)|infiltration]]
*[[Lymphocytosis]]
*[[Monocytosis]]
===Peripheral smear===
===Peripheral smear===
*Plasmacytoid lymphocytes
*[[Plasmacytoid]] [[lymphocytes]]
*Normocytic normochromic red blood cells
*[[Normocytic normochromic anemia|Normocytic normochromic red blood cells]]
*[[Rouleaux]] formation
*[[Rouleaux formation]]
 
===Chemistry Lab tests===
===Serum and urine protein electrophoresis===
*Elevated [[lactate dehydrogenase]] ([[LDH]]):<ref name="pmid19520758">{{cite journal| author=Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA et al.| title=Screening panels for detection of monoclonal gammopathies. | journal=Clin Chem | year= 2009 | volume= 55 | issue= 8 | pages= 1517-22 | pmid=19520758 | doi=10.1373/clinchem.2009.126664 | pmc=3773468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19520758  }} </ref>
*Screening test for waldenström's macroglobulinemia <ref name = qwer> Waldenström macroglobulinaemia. American Cancer Society (2015) http://www.cancer.org/cancer/waldenstrommacroglobulinemia/detailedguide/waldenstrom-macroglobulinemia-diagnosis Accessed on November 15th, 2015 </ref>
**Level indicates the extent of the [[disease]]
*Detection of M spike
*Elevated [[urea]] and [[creatinine]]
**[[Rare|Rarely]]
*[[Electrolyte abnormalities]]
**[[Hypercalcemia]]
**[[Hyponatremia]]
*Elevated [[erythrocyte sedimentation rate]] ([[ESR]])
*Elevated [[uric acid]] levels
*Positive [[rheumatoid factor]]
*Positive [[cryoglobulins]]
*Positive direct anti-[[globulin]] [[test]]
*Positive [[cold agglutinin titre]]
*Elevated [[beta-2-microglobulin]] in [[Proportionality (mathematics)|proportion]] to [[tumor]] [[mass]]
**Needed to evaluate [[prognosis]]


===Serum and urine immunofixation===
===Platelet function test and blood coagulation studies===
*Confirmatory test for waldenström's macroglobulinemia<ref name = qwer> Waldenström macroglobulinaemia. American Cancer Society (2015) http://www.cancer.org/cancer/waldenstrommacroglobulinemia/detailedguide/waldenstrom-macroglobulinemia-diagnosis Accessed on November 15th, 2015 </ref>
*Prolonged [[bleeding time]]<ref name="pmid4924493">{{cite journal| author=Penny R, Castaldi PA, Whitsed HM| title=Inflammation and haemostasis in paraproteinaemias. | journal=Br J Haematol | year= 1971 | volume= 20 | issue= 1 | pages= 35-44 | pmid=4924493 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4924493  }} </ref>
**Possibly due to [[interaction]] between [[platelet]] [[membrane]] [[Glycoprotein|glycoproteins]] and [[IgM]] [[paraprotein]]
*Prolonged [[prothrombin time]]
*Prolonged [[activated partial thromboplastin time]]
*Prolonged [[thrombin time]]
*[[Abnormalities]] related to [[fibrinogen]] levels


*Determines the IgM type of immunoglobulin
===Mutational analysis===
*'''[[MYD88]]''' [[gene]] [[mutation]] has been found in more than 90% of [[patients]] with [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]]<ref name="pmid23321251">{{cite journal| author=Xu L, Hunter ZR, Yang G, Zhou Y, Cao Y, Liu X et al.| title=MYD88 L265P in Waldenström macroglobulinemia, immunoglobulin M monoclonal gammopathy, and other B-cell lymphoproliferative disorders using conventional and quantitative allele-specific polymerase chain reaction. | journal=Blood | year= 2013 | volume= 121 | issue= 11 | pages= 2051-8 | pmid=23321251 | doi=10.1182/blood-2012-09-454355 | pmc=3596964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23321251  }} </ref>
===Cryocrit===
*This [[test]] [[Measure (mathematics)|measures]] the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can [[Blockhead|block]] [[blood vessels]])
===Cold agglutinins===
*[[Cold agglutinins]] are [[antibodies]] that [[Attack rate|attack]] and kill [[red blood cells]], especially at cooler [[temperatures]].
*These [[Dead body|dead]] [[Cells (biology)|cells]] can then [[Building biology|build]] up and [[Blockhead|block]] [[blood vessels]].
*A [[blood test]] can be used to [[Detection theory|detect]] these [[antibodies]].


===Chemistry lab tests===
===Beta-2 microglobulin (β2M)===
*Elevated [[beta-2-microglobulin]] in proportion to tumor mass
*This [[test]] [[Measure (data warehouse)|measures]] another [[protein]] made by the [[cancer cells]] in WM.
*Elevated [[lactate dehydrogenase]]
*This [[protein]] itself doesn’t [[Causes|cause]] any problems, but it’s a useful [[indicator]] of a [[Patient|patient’s]] [[prognosis]] (outlook).
*Elevated [[creatinine]]
*High levels of β2M are [[Link|linked]] with a worse outlook.
*Electrolyte abnormalities:
:*Hypercalcemia(4%)
*Elevated [[erythrocyte sedimentation rate]] and [[uric acid]]
*Total protein levels
*[[Albumin-to-globulin ratio]]
*[[Rheumatoid factor]], [[cryoglobulins]], direct anti-globulin test, and cold agglutinin titre results can be positive.
*[[Coagulation studies]] can be abnormal with elevated [[prothrombin time]], [[activated partial thromboplastin time]], and [[thrombin time]].


===Plasma viscosity===
===Urinanalysis===
*Plasma viscosity should be measured in patients presenting with [[hyperviscosity syndrome]] whenever the monoclonal IgM protein spike is >4 g/dL.
*[[Proteinuria]]
*The normal plasma viscosity is 1.8 centipoise.  
===Hepatitis Serology===
*Patients start presenting with hyperviscosity symptoms when viscosity >4 centipoise.
*[[Hepatitis C]] [[serology]] should be obtained for [[patients]] with [[cryoglobulinemia]].
*[[Hepatitis B]] [[serology]] should be obtained for [[patients]] whose [[Treatment Planning|planned treatment]] includes [[rituximab]].
===Antibody titers in patients with peripheral neuropathy===
*Anti-[[myelin]]-[[Association (statistics)|associated]] [[glycoprotein]]
*Anti-[[ganglioside]] M1
*Anti-[[sulfatide]] [[IgM]] [[antibodies]]


==References==
==References==

Latest revision as of 18:39, 15 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2], Roukoz A. Karam, M.D.[3], Mirdula Sharma, MBBS [4]; ; Grammar Reviewer: Natalie Harpenau, B.S.[5]

Overview

Laboratory findings consistent with the diagnosis of Waldenstrom's macroglobulinemia include any cytopenia, lymphocytosis, monocytosis, elevated levels of LDH, Beta-2 microglobulin, uric acid, and urea & creatinine, elevated ESR, hypercalcemia, hyponatremia, positive rheumatoid factor, positive cryoglobulins, positive direct anti-globulin test, positive cold agglutinin titre, proteinuria, prolonged bleeding time, prolonged prothrombin time, prolonged activated partial thromboplastin time, prolonged thrombin time and peripheral smear shows plasmacytoid lymphocytes, normocytic normochromic red blood cells and rouleaux formation.

Laboratory Findings

Complete blood count

Peripheral smear

Chemistry Lab tests

Platelet function test and blood coagulation studies

Mutational analysis

Cryocrit

Cold agglutinins

Beta-2 microglobulin (β2M)

Urinanalysis

Hepatitis Serology

Antibody titers in patients with peripheral neuropathy

References

  1. García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A; et al. (2001). "Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases". Br J Haematol. 115 (3): 575–82. PMID 11736938.
  2. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA; et al. (2009). "Screening panels for detection of monoclonal gammopathies". Clin Chem. 55 (8): 1517–22. doi:10.1373/clinchem.2009.126664. PMC 3773468. PMID 19520758.
  3. Penny R, Castaldi PA, Whitsed HM (1971). "Inflammation and haemostasis in paraproteinaemias". Br J Haematol. 20 (1): 35–44. PMID 4924493.
  4. Xu L, Hunter ZR, Yang G, Zhou Y, Cao Y, Liu X; et al. (2013). "MYD88 L265P in Waldenström macroglobulinemia, immunoglobulin M monoclonal gammopathy, and other B-cell lymphoproliferative disorders using conventional and quantitative allele-specific polymerase chain reaction". Blood. 121 (11): 2051–8. doi:10.1182/blood-2012-09-454355. PMC 3596964. PMID 23321251.

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