Waldenström's macroglobulinemia laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 5: Line 5:
==Laboratory Findings==
==Laboratory Findings==


*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).
====Complete blood count====
*Normocytic normochromic anemia - presents in 80% of patients<ref name="LAB">Waldenström's macroglobulinemia. Medscape (2015)http://emedicine.medscape.com/article/207097-workup#c7 Accessed on November 10, 2015</ref>
*Leukopenia
*Thrombocytopenia - presents in 50% of patients with bleeding diathesis


*General studies include a [[CBC]], red cell indices, [[platelet count]], and a [[peripheral smear]].
====Peripheral smear====
*Plasmacytoid lymphocytes
*Normocytic normochromic red blood cells
*Rouleaux formation


*[[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.  
====Chemistry lab tests====
*Lactate dehydrogenase - is elevated indicating the extent of tissue involvement.
*Creatinine is elevated.
*Electrolyte abnormalities can be present with hypercalcemia in 4% of patients with Waldenström's macroglobulinemia.
*Erythrocyte Sedimentation Rate and uric acid may be elevated.
*Renal and hepatic function
*Total protein levels
*Albumin-to-globulin ratio
*Rheumatoid factor, cryoglobulins, direct antiglobulin test and cold agglutinin titre results can be positive.
*Beta-2-microglobulin is elevated in proportion to tumor mass.
*Coaglulation studies can be abnormal with elevated prothrombin time, activated partial thromboplastin time, and thrombin time.


*The [[peripheral smear]] may reveal plasmacytoid [[lymphocyte]]s, normocytic normochromic red cells, and [[rouleaux formation]].  
====Nerve conduction study====
*Patients with Waldenström's macroglobulinemia should have nerve conduction study and [[antimyelin associated glycoprotein]] serology should be done.


*[[Neutropenia]] can be found in some patients.  
====Plasma viscosity====
*Plasma viscosity should be measured in patients presenting with hyperviscosity syndrome.


*[[Thrombocytopenia]] is found in approximately 50% of patients with bleeding diathesis.
References:
 
{{Reflist|2}}
*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==
{{reflist|2}}
 
{{WH}}
{{WS}}
 
[[Category:Disease]]
[[Category:Blood]]
[[Category:Hematology]]

Revision as of 15:28, 10 November 2015

Waldenström's macroglobulinemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Waldenström's macroglobulinemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Bone Marrow Aspiration and Biopsy

Electrophoresis and Immunofixation

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Waldenström's macroglobulinemia laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Waldenström's macroglobulinemia laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Waldenström's macroglobulinemia laboratory findings

CDC on Waldenström's macroglobulinemia laboratory findings

Waldenström's macroglobulinemia laboratory findings in the news

Blogs on Waldenström's macroglobulinemia laboratory findings

Directions to Hospitals Treating Waldenström's macroglobulinemia

Risk calculators and risk factors for Waldenström's macroglobulinemia laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory Findings

Complete blood count

  • Normocytic normochromic anemia - presents in 80% of patients[1]
  • Leukopenia
  • Thrombocytopenia - presents in 50% of patients with bleeding diathesis

Peripheral smear

  • Plasmacytoid lymphocytes
  • Normocytic normochromic red blood cells
  • Rouleaux formation

Chemistry lab tests

  • Lactate dehydrogenase - is elevated indicating the extent of tissue involvement.
  • Creatinine is elevated.
  • Electrolyte abnormalities can be present with hypercalcemia in 4% of patients with Waldenström's macroglobulinemia.
  • Erythrocyte Sedimentation Rate and uric acid may be elevated.
  • Renal and hepatic function
  • Total protein levels
  • Albumin-to-globulin ratio
  • Rheumatoid factor, cryoglobulins, direct antiglobulin test and cold agglutinin titre results can be positive.
  • Beta-2-microglobulin is elevated in proportion to tumor mass.
  • Coaglulation studies can be abnormal with elevated prothrombin time, activated partial thromboplastin time, and thrombin time.

Nerve conduction study

Plasma viscosity

  • Plasma viscosity should be measured in patients presenting with hyperviscosity syndrome.

References:

  1. ↑ Waldenström's macroglobulinemia. Medscape (2015)http://emedicine.medscape.com/article/207097-workup#c7 Accessed on November 10, 2015
Retrieved from "https://www.wikidoc.org/index.php?title=Waldenström%27s_macroglobulinemia_laboratory_findings&oldid=1185232"