Cryoglobulinemia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Pathophysiology

It is important to note that these two different, yet highly representative, clinical syndromes generally reflect different types of underlying CG:

1. Hyperviscosity is typically associated with CG due to hematological malignancies and monoclonal immunoglobulins.
2. "Meltzer's triad" of palpable purpura, arthralgia and myalgia is generally seen with polyclonal CGs seen in essential-, viral-, or connective tissue disease-associated CG.

• MC is closely associated with hepatitis C infection and is thought to activate B lymphocytes by binding to CD81.
• 80-95% of patients with MC have circulating anti-HCV antibodies or circulating HCV RNA in the serum or within the cryoprecipitate.
• Polyclonal IgG anti-HCV have been noted in the cryoprecipitate as well.
• Approximately 50% of patients with chronic hepatitis C and 15% with hepatitis B will have circulating MC (1/2 Type II, 2/3 Type III).
• It is unclear what the antigen trigger is for production of the MC, but it is though that the hepatitis C viral RNA itself may be the factor since it is found in high quantities in the cryoprecipitate.

References

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