Lymphoplasmacytic lymphoma laboratory findings: Difference between revisions

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{{Lymphoplasmacytic lymphoma}}
{{Lymphoplasmacytic lymphoma}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{S.M.}}  


==Overview==
==Overview==
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
[[Laboratory]] findings consistent with the [[diagnosis]] of [[lymphoplasmacytic lymphoma]] 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]].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal for patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


==Laboratory Findings==
==Laboratory Findings==
*[[Lymphoplasmacytic lymphoma|LPL]] 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 [[Lymphoplasmacytic lymphoma|LPL]] [[diagnosis]].
*[[Laboratory]] findings consistent with the [[diagnosis]] of [[lymphoplasmacytic lymphoma]] 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===
*[[Anemia]]:
**Seen in 40% of [[New|newly]] [[Diagnose|diagnosed]] [[patients]] and in 80% of [[symptomatic]] [[patients]] with [[lymphoplasmacytic lymphoma]]
**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===
*[[Plasmacytoid]] [[lymphocytes]]
*[[Normocytic normochromic anemia|Normocytic normochromic red blood cells]]
*[[Rouleaux formation]]
===Chemistry Lab tests===
*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>
**Level indicates the extent of the [[disease]]
*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]]


There are no diagnostic laboratory findings associated with [disease name].
===Platelet function test and blood coagulation studies===
 
*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>
OR
**Possibly due to [[interaction]] between [[platelet]] [[membrane]] [[Glycoprotein|glycoproteins]] and [[IgM]] [[paraprotein]]
 
*Prolonged [[prothrombin time]]
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
*Prolonged [[activated partial thromboplastin time]]
 
*Prolonged [[thrombin time]]
OR
*[[Abnormalities]] related to [[fibrinogen]] levels
 
[Test] is usually normal among patients with [disease name].


OR
===Mutational analysis===
*'''[[MYD88]]''' [[gene]] [[mutation]] has been found in more than 90% of [[patients]] with [[lymphoplasmacytic lymphoma]]<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><ref name="pmid27722129">{{cite journal| author=Shin SY, Lee ST, Kim HY, Park CH, Kim HJ, Kim JW et al.| title=Detection of MYD88 L265P in patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia and other B-cell non-Hodgkin lymphomas. | journal=Blood Res | year= 2016 | volume= 51 | issue= 3 | pages= 181-186 | pmid=27722129 | doi=10.5045/br.2016.51.3.181 | pmc=5054250 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27722129  }}</ref>


Laboratory findings consistent with the diagnosis of [disease name] include:
===Cryocrit===
*[Abnormal test 1]
*This [[test]] [[Measure (mathematics)|measures]] the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can [[Blockhead|block]] [[blood vessels]])
*[Abnormal test 2]
===Cold agglutinins===
*[Abnormal test 3]
*[[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]].


OR
===Beta-2 microglobulin (β2M)===
*This [[test]] [[Measure (data warehouse)|measures]] another [[protein]] made by the [[cancer cells]] in LPL.<ref name="pmid25325033">{{cite journal| author=Yoo C, Yoon DH, Suh C| title=Serum beta-2 microglobulin in malignant lymphomas: an old but powerful prognostic factor. | journal=Blood Res | year= 2014 | volume= 49 | issue= 3 | pages= 148-53 | pmid=25325033 | doi=10.5045/br.2014.49.3.148 | pmc=4188779 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25325033  }}</ref><ref name="pmid4558655">{{cite journal| author=Peterson PA, Cunningham BA, Berggård I, Edelman GM| title=2 -Microglobulin--a free immunoglobulin domain. | journal=Proc Natl Acad Sci U S A | year= 1972 | volume= 69 | issue= 7 | pages= 1697-701 | pmid=4558655 | doi=10.1073/pnas.69.7.1697 | pmc=426781 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4558655  }}</ref>
*This [[protein]] itself doesn’t [[Causes|cause]] any problems, but it’s a useful [[indicator]] of a [[Patient|patient’s]] [[prognosis]] (outlook).
*High levels of β2M are [[Link|linked]] with a worse outlook.


Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
===Urinalysis===
*[[Proteinuria]]
===Hepatitis Serology===
*[[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]]<ref name="pmid21320835">{{cite journal| author=Klein CJ, Moon JS, Mauermann ML, Zeldenrust SR, Wu Y, Dispenzieri A et al.| title=The neuropathies of Waldenström's macroglobulinemia (WM) and IgM-MGUS. | journal=Can J Neurol Sci | year= 2011 | volume= 38 | issue= 2 | pages= 289-95 | pmid=21320835 | doi=10.1017/s0317167100011483 | pmc=3901797 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21320835  }}</ref><ref name="pmid16421127">{{cite journal| author=Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T et al.| title=Peripheral neuropathies in Waldenström's macroglobulinaemia. | journal=J Neurol Neurosurg Psychiatry | year= 2006 | volume= 77 | issue= 2 | pages= 224-8 | pmid=16421127 | doi=10.1136/jnnp.2005.071175 | pmc=2077569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16421127  }}</ref><ref name="pmid7504399">{{cite journal| author=Baldini L, Nobile-Orazio E, Guffanti A, Barbieri S, Carpo M, Cro L et al.| title=Peripheral neuropathy in IgM monoclonal gammopathy and Wäldenstrom's macroglobulinemia: a frequent complication in elderly males with low MAG-reactive serum monoclonal component. | journal=Am J Hematol | year= 1994 | volume= 45 | issue= 1 | pages= 25-31 | pmid=7504399 | doi=10.1002/ajh.2830450105 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7504399  }}</ref>
*Anti-[[ganglioside]] M1
*Anti-[[sulfatide]] [[IgM]] [[antibodies]]


==References==
==References==

Latest revision as of 16:49, 29 October 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]

Overview

Laboratory findings consistent with the diagnosis of lymphoplasmacytic lymphoma 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)

Urinalysis

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.
  5. ↑ Shin SY, Lee ST, Kim HY, Park CH, Kim HJ, Kim JW; et al. (2016). "Detection of MYD88 L265P in patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia and other B-cell non-Hodgkin lymphomas". Blood Res. 51 (3): 181–186. doi:10.5045/br.2016.51.3.181. PMC 5054250. PMID 27722129.
  6. ↑ Yoo C, Yoon DH, Suh C (2014). "Serum beta-2 microglobulin in malignant lymphomas: an old but powerful prognostic factor". Blood Res. 49 (3): 148–53. doi:10.5045/br.2014.49.3.148. PMC 4188779. PMID 25325033.
  7. ↑ Peterson PA, Cunningham BA, Berggård I, Edelman GM (1972). "2 -Microglobulin--a free immunoglobulin domain". Proc Natl Acad Sci U S A. 69 (7): 1697–701. doi:10.1073/pnas.69.7.1697. PMC 426781. PMID 4558655.
  8. ↑ Klein CJ, Moon JS, Mauermann ML, Zeldenrust SR, Wu Y, Dispenzieri A; et al. (2011). "The neuropathies of Waldenström's macroglobulinemia (WM) and IgM-MGUS". Can J Neurol Sci. 38 (2): 289–95. doi:10.1017/s0317167100011483. PMC 3901797. PMID 21320835.
  9. ↑ Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T; et al. (2006). "Peripheral neuropathies in Waldenström's macroglobulinaemia". J Neurol Neurosurg Psychiatry. 77 (2): 224–8. doi:10.1136/jnnp.2005.071175. PMC 2077569. PMID 16421127.
  10. ↑ Baldini L, Nobile-Orazio E, Guffanti A, Barbieri S, Carpo M, Cro L; et al. (1994). "Peripheral neuropathy in IgM monoclonal gammopathy and Wäldenstrom's macroglobulinemia: a frequent complication in elderly males with low MAG-reactive serum monoclonal component". Am J Hematol. 45 (1): 25–31. doi:10.1002/ajh.2830450105. PMID 7504399.

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