Waldenström's macroglobulinemia laboratory findings: Difference between revisions

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__NOTOC__
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{{Waldenström's macroglobulinemia}}
{{Waldenström's macroglobulinemia}}
{{CMG}}
{{CMG}}; {{AE}} {{S.M.}}, {{RAK}}, {{MGS}}; ; {{GRR}} {{Nat}}
 
==Overview==
==Overview==
[[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===
*[[Anemia]]:
**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]]
*[[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]]


*The laboratory diagnosis of Waldenström's macroglobulinemia is contingent on demonstrating a significant monoclonal [[IgM]] spike and identifying malignant cells consistent with Waldenström's macroglobulinemia (usually found in bone marrow biopsy samples and aspirates).
===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>
*General studies include a [[CBC]], red cell indices, [[platelet count]], and a [[peripheral smear]].
**Possibly due to [[interaction]] between [[platelet]] [[membrane]] [[Glycoprotein|glycoproteins]] and [[IgM]] [[paraprotein]]
 
*Prolonged [[prothrombin time]]
*[[Normocytic normochromic anemia]], [[leukopenia]], and [[thrombocytopenia]] may be observed. [[Anemia]] is the most common finding, present in 80% of patients with symptomatic Waldenström's macroglobulinemia.
*Prolonged [[activated partial thromboplastin time]]
*Prolonged [[thrombin time]]
*[[Abnormalities]] related to [[fibrinogen]] levels


*The [[peripheral smear]] may reveal plasmacytoid [[lymphocyte]]s, normocytic normochromic red cells, and [[rouleaux formation]].  
===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]].


*[[Neutropenia]] can be found in some patients.  
===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.


*[[Thrombocytopenia]] is found in approximately 50% of patients with bleeding diathesis.
===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]]


*Chemistry tests include [[lactate dehydrogenase]] ([[LDH]]) levels, [[uric acid]] levels, [[erythrocyte sedimentation rate]] ([[ESR]]), renal and [[hepatic function test]]s, [[total protein]] levels, and an [[albumin-to-globulin ratio]]. The [[ESR]] and [[uric acid]] level may be elevated.
*[[Creatinine]] is occasionally elevated and electrolytes are occasionally abnormal. [[Hypercalcemia]] is noted in approximately 4% of patients.
*The [[LDH]] level is frequently elevated, indicating the extent of Waldenström's macroglobulinemia–related tissue involvement.
*[[Rheumatoid factor]], [[cryoglobulin]]s, [[direct antiglobulin test]] and [[cold agglutinin titre]] results can be positive.
*Beta-2-microglobulin and [[C-reactive protein]] test results are not specific for Waldenström's macroglobulinemia. Beta-2-microglobulin is elevated in proportion to tumor mass.
*Coagulation abnormalities may be present. Prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen tests should be performed. Platelet aggregation studies are optional.
*Serum [[protein electrophoresis]] results indicate evidence of a monoclonal spike but cannot establish the spike as IgM. An M component with beta-to-gamma mobility is highly suggestive of Waldenström's macroglobulinemia.
* A distinguishing feature of WM is the presence of an [[IgM monoclonal protein]] (or [[paraprotein]]) that is produced by the cancer cells, and a concurrent decrease in levels of uninvolved [[immunoglobulins]] (i.e., [[IgG]] and [[IgA]]).
*Immunoelectrophoresis and immunofixation studies help identify the type of immunoglobulin, the clonality of the light chain, and the monoclonality and quantitation of the paraprotein.
*High-resolution electrophoresis and serum and urine immunofixation are recommended to help identify and characterize the monoclonal IgM paraprotein.
*The light chain of the monoclonal protein is usually the kappa light chain. At times, patients with Waldenström's macroglobulinemia may exhibit more than one M protein.
*Plasma viscosity must be measured.
*Results from characterization studies of urinary immunoglobulins indicate that light chains ([[Bence Jones protein]]), usually of the kappa type, are found in the urine.
*Urine collections should be concentrated.
*[[Bence Jones protein|Bence Jones proteinuria]] is observed in approximately 40% of patients and exceeds 1 g/d in approximately 3% of patients.
*Patients with findings of [[peripheral neuropathy]] should have nerve conduction studies and [[antimyelin associated glycoprotein]] serology
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Blood]]
[[Category:Blood]]
[[Category:Oncology]]
[[Category:Hematology]]
[[Category:Hematology]]

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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