Lymphoplasmacytic lymphoma laboratory findings: Difference between revisions
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==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]]. | * 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 tests are done that a [[biopsy]] of either the [[bone marrow]] or a [[lymph node]] is considered to confirm the LPL [[diagnosis]]. | ||
***Seen in 40% of newly diagnosed patients and in 80% of [[symptomatic]] patients with [[lymphoplasmacytic lymphoma]] | * Laboratory findings consistent with the [[diagnosis]] of [[lymphoplasmacytic lymphoma]] 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> | ||
***Multi-factorial [[causes]] including: decreased [[RBC]] synthesis due to [[bone marrow infiltration]], [[iron deficiency]] due to [[gastrointestinal bleeding]], and [[chronic inflammation]] | |||
**[[Thrombocytopenia]] | * '''Complete blood count''' | ||
***Due to [[bone marrow]] [[Infiltration (medical)|infiltration]] | **[[Anemia]] | ||
***Seen in 40% of newly diagnosed patients and in 80% of [[symptomatic]] patients with [[lymphoplasmacytic lymphoma]] | |||
***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]] | **[[Neutropenia]] | ||
***Due to [[bone marrow]] [[Infiltration (medical)|infiltration]] | ***Due to [[bone marrow]] [[Infiltration (medical)|infiltration]] | ||
**[[Lymphocytosis]] | **[[Lymphocytosis]] | ||
**[[Monocytosis]] | **[[Monocytosis]] | ||
* '''Peripheral smear''' | * '''Peripheral smear''' | ||
**[[Plasmacytoid]] [[lymphocytes]] | **[[Plasmacytoid]] [[lymphocytes]] | ||
**[[Normocytic normochromic anemia|Normocytic normochromic red blood cells]] | **[[Normocytic normochromic anemia|Normocytic normochromic red blood cells]] | ||
**[[Rouleaux formation]] | **[[Rouleaux formation]] | ||
* '''Chemistry Lab tests | * '''Chemistry Lab tests'''<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> | ||
**Elevated [[lactate dehydrogenase]] ([[LDH]]) | **Elevated [[lactate dehydrogenase]] ([[LDH]]) | ||
***Level indicates the extent of the disease | ***Level indicates the extent of the disease | ||
**Elevated [[urea]] and [[creatinine]] | **Elevated [[urea]] and [[creatinine]] | ||
***Rarely | ***Rarely | ||
**[[Electrolyte abnormalities]] | **[[Electrolyte abnormalities]] | ||
***[[Hypercalcemia]] | ***[[Hypercalcemia]] | ||
***[[Hyponatremia]] | ***[[Hyponatremia]] | ||
**Elevated [[erythrocyte sedimentation rate]] ([[ESR]]) and [[uric acid]] | **Elevated [[erythrocyte sedimentation rate]] ([[ESR]]) and [[uric acid]] | ||
**[[Rheumatoid factor]], [[cryoglobulins]], direct anti-[[globulin]] test, and [[cold agglutinin titre]] results can be positive | **[[Rheumatoid factor]], [[cryoglobulins]], direct anti-[[globulin]] test, and [[cold agglutinin titre]] results can be positive | ||
**Elevated [[beta-2-microglobulin]] in proportion to [[tumor]] mass | **Elevated [[beta-2-microglobulin]] in proportion to [[tumor]] mass | ||
*** Needed to evaluate [[prognosis]] | *** Needed to evaluate [[prognosis]] | ||
* '''Platelet function test and blood coagulation studies | * '''Platelet function test and blood coagulation studies''' | ||
** Prolonged [[bleeding time]] | ** 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]] | *** Possibly due to interaction between [[platelet]] membrane [[Glycoprotein|glycoproteins]] and [[IgM]] [[paraprotein]] | ||
** Abnormalities in [[prothrombin time]], [[activated partial thromboplastin time]], [[thrombin time]], and [[fibrinogen]] | ** Abnormalities in [[prothrombin time]], [[activated partial thromboplastin time]], [[thrombin time]], and [[fibrinogen]] | ||
* '''Mutational analysis | * '''Mutational analysis''' The ''[[MYD88]]'' [[gene]] [[mutation]] has been found in more than 90% of patients with [[lymphoplasmacytic lymphoma]]<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 | *'''Cryocrit''' | ||
**This test measures the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can block [[blood vessels]]) | **This test measures the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can block [[blood vessels]]) | ||
*'''Cold agglutinins | *'''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]]. | **[[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) | *'''Beta-2 microglobulin (β2M)''' | ||
**This test measures another [[protein]] made by the [[cancer cells]] in LPL. This [[protein]] itself doesn’t cause any problems, but it’s a useful indicator of a patient’s [[prognosis]] (outlook). High levels of β2M are linked with a worse outlook. | **This test measures another [[protein]] made by the [[cancer cells]] in LPL. This [[protein]] itself doesn’t cause any problems, but it’s a useful indicator of a patient’s [[prognosis]] (outlook). High levels of β2M are linked with a worse outlook. | ||
*'''Urinanalysis | *'''Urinanalysis''' | ||
**[[Proteinuria]] | **[[Proteinuria]] | ||
* '''Serology | * '''Serology''' | ||
**[[Hepatitis C]] [[serology]] should be obtained for patients with [[cryoglobulinemia]]. | **[[Hepatitis C]] [[serology]] should be obtained for patients with [[cryoglobulinemia]]. | ||
**[[Hepatitis B]] [[serology]] should be obtained for patients whose planned treatment includes [[rituximab]]. | **[[Hepatitis B]] [[serology]] should be obtained for patients whose planned treatment includes [[rituximab]]. | ||
Revision as of 02:16, 21 February 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]
Overview
Patients with lymphoplasmacytic lymphoma usually appear oriented to time, place, and person. Physical examination of patients with lymphoplasmacytic lymphoma is usually remarkable for various findings depending on the degree of tissue infiltration by malignant tumor cells, hyperviscosity syndrome, and accumulation of paraprotein.
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 tests are done that a biopsy of either the bone marrow or a lymph node is considered to confirm the LPL diagnosis.
- Laboratory findings consistent with the diagnosis of lymphoplasmacytic lymphoma include:[1]
- Complete blood count
- Anemia
- Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with lymphoplasmacytic lymphoma
- 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
- 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 lymphoplasmacytic lymphoma[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 LPL. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis (outlook). High levels of β2M are linked with a worse outlook.
- 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.