Waldenström's macroglobulinemia 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. Usually after that, a blood test called [[serum protein electrophoresis]] is ordered to find out what type of protein is there. Typically, after these 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 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:''' | * '''Complete blood count:''' | ||
**[[Anemia]] | **[[Anemia]] | ||
***Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia | ***Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia | ||
***Multi-factorial causes including: decreased RBC synthesis due to [[bone marrow infiltration]], [[iron deficiency]] due to [[gastrointestinal bleeding]], and [[chronic inflammation]]. | ***Multi-factorial causes including: decreased RBC synthesis due to [[bone marrow infiltration]], [[iron deficiency]] due to [[gastrointestinal bleeding]], and [[chronic inflammation]]. | ||
**[[Thrombocytopenia]] | **[[Thrombocytopenia]] | ||
***Due to bone marrow infiltration | ***Due to bone marrow infiltration | ||
**** | **** | ||
**[[Neutropenia]] | **[[Neutropenia]] | ||
***Due to bone marrow infiltration | ***Due to bone marrow 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:'''<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> | * '''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:''' The ''[[MYD88]]'' gene mutation has been found in more than 90% of patients with Waldenstrom's macroglobulinemia | * '''Mutational analysis:''' The ''[[MYD88]]'' gene mutation has been found in more than 90% of patients with 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:''' | *'''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 WM. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis | **This test measures another protein made by the cancer cells in WM. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s [[prognosis]]. High levels of β2M are linked with a worse prognosis. | ||
*'''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. | ||
**Anti-myelin-associated glycoprotein, anti-ganglioside M1 and anti-sulfatide IgM antibodies in patients with peripheral neuropathy. | **Anti-myelin-associated [[glycoprotein]], anti-ganglioside M1, and anti-sulfatide IgM antibodies in patients with [[peripheral neuropathy]]. | ||
==References== | ==References== | ||
Revision as of 18:26, 8 April 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]
Overview
Laboratory findings consistent with the diagnosis of Waldenström's macroglobulinemia include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.
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. Typically, after these 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 macroglobulinemia include:[1]
- Complete blood count:
- Anemia
- Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström'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
- Due to bone marrow infiltration
- Neutropenia
- Due to bone marrow infiltration
- Lymphocytosis
- Monocytosis
- Anemia
- Peripheral smear:
- Plasmacytoid lymphocytes
- Normocytic normochromic red blood cells
- Rouleaux formation
- 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 Waldenstrom's macroglobulinemia[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 WM. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis. High levels of β2M are linked with a worse prognosis.
- 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.