Lymphoplasmacytic lymphoma laboratory findings: Difference between revisions
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* 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]]. | * 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:<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> | * 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> | ||
===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 (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===<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]]) | |||
**Level indicates the extent of the disease | |||
*Elevated [[urea]] and [[creatinine]] | |||
**Rarely | |||
*[[Electrolyte abnormalities]] | |||
**[[Hypercalcemia]] | |||
**[[Hyponatremia]] | |||
*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]] | |||
===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> | |||
**Possibly due to interaction between [[platelet]] membrane [[Glycoprotein|glycoproteins]] and [[IgM]] [[paraprotein]] | |||
*Abnormalities in [[prothrombin time]], [[activated partial thromboplastin time]], [[thrombin time]], and [[fibrinogen]] | |||
===Mutational analysis=== | |||
*'''[[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=== | |||
*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=== | |||
*[[Proteinuria]] | |||
===Serology=== | |||
*[[Hepatitis C]] [[serology]] should be obtained for patients with [[cryoglobulinemia]]. | |||
*[[Hepatitis B]] [[serology]] should be obtained for patients whose planned treatment includes [[rituximab]]. | |||
===Antibody titers in patients with peripheral neuropathy=== | |||
***Anti-[[myelin]]-associated [[glycoprotein]] | ***Anti-[[myelin]]-associated [[glycoprotein]] | ||
***Anti-[[ganglioside]] M1 | ***Anti-[[ganglioside]] M1 | ||
Revision as of 02:28, 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
- Neutropenia
- Due to bone marrow infiltration
- Lymphocytosis
- Monocytosis
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
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
Mutational analysis
- 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.
Antibody titers in patients with peripheral neuropathy
- Anti-myelin-associated glycoprotein
- Anti-ganglioside M1
- Anti-sulfatide IgM antibodies
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.