Waldenström's macroglobulinemia laboratory findings: Difference between revisions

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


==Overview==
==Overview==
Laboratory findings consistent with the diagnosis of Waldenström's macroglobulinemia include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.
[[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==
Laboratory findings consistent with the diagnosis of Waldenström macroglobulinemia include:
* WM is mostly suspected when a [[patient]] has low [[blood counts]] and/or high levels of unusual [[protein]] levels on [[blood tests]].
* '''Complete blood count''':
* Usually after that, a [[blood test]] called [[serum protein electrophoresis]] is ordered to find out what type of [[protein]] is there.
**Anemia
* 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]].
***Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia
*[[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>
***Multifactorial causes including: decreased RBC synthesis due to bone marrow infiltration, iron deficiency due to gastrointestinal bleeding, chronic inflammation.
===Complete blood count===
**[[Thrombocytopenia]]
*[[Anemia]]:
***Due to bone marrow infiltration
**Seen in 40% of [[New|newly]] [[Diagnose|diagnosed]] [[patients]] and in 80% of [[symptomatic]] [[patients]] with [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]]
****
**Multi-factorial [[causes]] including: decreased [[RBC]] [[synthesis]] due to [[bone marrow infiltration]], [[iron deficiency]] due to [[gastrointestinal bleeding]], and [[chronic inflammation]]
**Neutropenia
*[[Thrombocytopenia]]:
***Due to bone marrow infiltration
**Due to [[bone marrow]] [[Infiltration (medical)|infiltration]]
**Lymphocytosis
*[[Neutropenia]]:
**Monocytosis
**Due to [[bone marrow]] [[Infiltration (medical)|infiltration]]
* '''Peripheral smear''':
*[[Lymphocytosis]]
**Plasmacytoid lymphocytes
*[[Monocytosis]]
**Normocytic normochromic red blood cells
===Peripheral smear===
**[[Rouleaux]] formation
*[[Plasmacytoid]] [[lymphocytes]]
* '''Serum and urine protein electrophoresis:'''
*[[Normocytic normochromic anemia|Normocytic normochromic red blood cells]]
**Screening test for Waldenström 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>
*[[Rouleaux formation]]
**Detection of M spike
===Chemistry Lab tests===
* '''Serum and urine immunofixation'''
*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>
**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>
**Level indicates the extent of the [[disease]]
**Determines the IgM type of immunoglobulin
*Elevated [[urea]] and [[creatinine]]
* '''Chemistry Lab tests'''
**[[Rare|Rarely]]
**Elevated [[beta-2-microglobulin]] in proportion to tumor mass
*[[Electrolyte abnormalities]]
**Elevated [[lactate dehydrogenase]]
**[[Hypercalcemia]]
**Elevated [[creatinine]]
**[[Hyponatremia]]
**Electrolyte abnormalities:
*Elevated [[erythrocyte sedimentation rate]] ([[ESR]])
***[[Hypercalcemia]](4%)
*Elevated [[uric acid]] levels
**Elevated [[erythrocyte sedimentation rate]] and [[uric acid]]
*Positive [[rheumatoid factor]]
**Total protein levels
*Positive [[cryoglobulins]]
**[[Albumin-to-globulin ratio]]
*Positive direct anti-[[globulin]] [[test]]
**[[Rheumatoid factor]], [[cryoglobulins]], direct anti-globulin test, and cold agglutinin titre results can be positive.  
*Positive [[cold agglutinin titre]]
**[[Coagulation studies]] can be abnormal with elevated [[prothrombin time]], [[activated partial thromboplastin time]], and [[thrombin time]].
*Elevated [[beta-2-microglobulin]] in [[Proportionality (mathematics)|proportion]] to [[tumor]] [[mass]]
* '''Plasma viscosity'''
**Needed to evaluate [[prognosis]]
**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.
===Platelet function test and blood coagulation studies===
**Patient presents with hyperviscosity symptoms with viscosity >4 centipoise.
*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
 
===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]].
 
===Beta-2 microglobulin (β2M)===
*This [[test]] [[Measure (data warehouse)|measures]] another [[protein]] made by the [[cancer cells]] in WM.
*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.
 
===Urinanalysis===
*[[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]]
*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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