Waldenström's macroglobulinemia laboratory findings

Waldenström's macroglobulinemia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Mirdula Sharma, MBBS [3]

Overview

Laboratory findings consistent with the diagnosis of Waldenström's macroglobulinemia include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.

Laboratory Findings

Laboratory findings consistent with the diagnosis of [disease name] include:

• Complete blood count:
  • Anemia
    • Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia
    • Multifactorial causes including: decreased RBC synthesis due to bone marrow infiltration, iron deficiency due to gastrointestinal bleeding, chronic inflammation.
  • Thrombocytopenia
    • Due to bone marrow infiltration
  • Neutropenia
    • Due to bone marrow infiltration
  • Lymphocytosis
  • Monocytosis
• Peripheral smear:
  • Plasmacytoid lymphocytes
  • Normocytic normochromic red blood cells
  • Rouleaux formation
• Serum and urine protein electrophoresis:
  • Screening test for Waldenström macroglobulinemia
  • Detection of M spike
• Serum and urine immunofixation
  • Confirmatory test for waldenström's macroglobulinemia
  • Determines the IgM type of immunoglobulin
• Chemistry Lab tests
  • Elevated beta-2-microglobulin in proportion to tumor mass
  • Elevated lactate dehydrogenase
  • Elevated creatinine
  • 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
  • Plasma viscosity should be measured in patients presenting with hyperviscosity syndrome whenever the monoclonal IgM protein spike is >4 g/dL.
  • The normal plasma viscosity is 1.8 centipoise.
  • Patient presents with hyperviscosity symptoms with viscosity >4 centipoise.