Waldenström's macroglobulinemia laboratory findings
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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]
Overview
Laboratory findings consistent with the diagnosis of Waldenström's macroglobulinemia include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.
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. Typically, after these 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 macroglobulinemia include:[1]
- Complete blood count:
- Anemia
- Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia
- 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
- Due to bone marrow infiltration
- Neutropenia
- Due to bone marrow infiltration
- Lymphocytosis
- Monocytosis
- Anemia
- Peripheral smear:
- Plasmacytoid lymphocytes
- Normocytic normochromic red blood cells
- Rouleaux formation
- Chemistry Lab tests:[2]
- Elevated lactate dehydrogenase (LDH)
- Level indicates the extent of the disease
- Elevated urea and creatinine
- Rarely
- Electrolyte abnormalities:
- Elevated erythrocyte sedimentation rate (ESR) and uric acid
- Rheumatoid factor, cryoglobulins, direct anti-globulin test, and cold agglutinin titre results can be positive
- Elevated beta-2-microglobulin in proportion to tumor mass
- Needed to evaluate prognosis
- Elevated lactate dehydrogenase (LDH)
- Platelet function test and blood coagulation studies:
- Prolonged bleeding time[3]
- Possibly due to interaction between platelet membrane glycoproteins and IgM paraprotein
- Abnormalities in prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen
- Prolonged bleeding time[3]
- Mutational analysis: The MYD88 gene mutation has been found in more than 90% of patients with Waldenstrom's macroglobulinemia[4]
- Cryocrit:
- This test measures the blood levels of cryoglobulins (proteins that clump together in cool temperatures and can block blood vessels).
- Cold agglutinins:
- Cold agglutinins are antibodies that attack and kill red blood cells, especially at cooler temperatures. These dead cells can then build up and block blood vessels. A blood test can be used to detect these antibodies.
- Beta-2 microglobulin (β2M):
- This test measures another protein made by the cancer cells in WM. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis. High levels of β2M are linked with a worse prognosis.
- Urinanalysis:
- Serology:
- Hepatitis C serology should be obtained for patients with cryoglobulinemia.
- Hepatitis B serology should be obtained for patients whose planned treatment includes rituximab.
- Anti-myelin-associated glycoprotein, anti-ganglioside M1, and anti-sulfatide IgM antibodies in patients with peripheral neuropathy.
References
- ↑ 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.
- ↑ 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.
- ↑ Penny R, Castaldi PA, Whitsed HM (1971). "Inflammation and haemostasis in paraproteinaemias". Br J Haematol. 20 (1): 35–44. PMID 4924493.
- ↑ 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.