Lymphoplasmacytic lymphoma laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
[[Laboratory]] findings consistent with the [[diagnosis]] of [[lymphoplasmacytic lymphoma]] include any [[cytopenia]], elevated [[Lactate dehydrogenase|LDH]], and elevated [[Beta-2 microglobulin]]. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
* | * LPL 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. | * 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]]. | * Mostly, only after these [[Test|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=== | ===Complete blood count=== | ||
*[[Anemia]] | *[[Anemia]]: | ||
**Seen in 40% of newly diagnosed patients and in 80% of [[symptomatic]] patients with [[lymphoplasmacytic lymphoma]] | **Seen in 40% of [[New|newly]] [[Diagnose|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]] | **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 (medical)|infiltration]] | **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]] | ||
| Line 27: | Line 27: | ||
*[[Rouleaux formation]] | *[[Rouleaux formation]] | ||
===Chemistry Lab tests=== | ===Chemistry Lab tests=== | ||
*Elevated [[lactate dehydrogenase]] ([[LDH]])<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]]):<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> | ||
**Level indicates the extent of the disease | **Level indicates the extent of the [[disease]] | ||
*Elevated [[urea]] and [[creatinine]] | *Elevated [[urea]] and [[creatinine]] | ||
**Rarely | **[[Rare|Rarely]] | ||
*[[Electrolyte abnormalities]] | *[[Electrolyte abnormalities]] | ||
**[[Hypercalcemia]] | **[[Hypercalcemia]] | ||
| Line 38: | Line 38: | ||
*Positive [[Rheumatoid factor]] | *Positive [[Rheumatoid factor]] | ||
*Positive [[cryoglobulins]] | *Positive [[cryoglobulins]] | ||
*Positive direct anti-[[globulin]] test | *Positive direct anti-[[globulin]] [[test]] | ||
*Positive [[cold agglutinin titre]] | *Positive [[cold agglutinin titre]] | ||
*Elevated [[beta-2-microglobulin]] in proportion to [[tumor]] mass | *Elevated [[beta-2-microglobulin]] in [[Proportionality (mathematics)|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]]<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> | *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]] | ||
*Prolonged [[prothrombin time]] | *Prolonged [[prothrombin time]] | ||
*Prolonged [[activated partial thromboplastin time]] | *Prolonged [[activated partial thromboplastin time]] | ||
*Prolonged [[thrombin time]] | *Prolonged [[thrombin time]] | ||
*Abnormalities related to [[fibrinogen]] levels | *[[Abnormalities]] related to [[fibrinogen]] levels | ||
===Mutational analysis=== | ===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> | *'''[[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]] [[Measure (mathematics)|measures]] the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can [[Blockhead|block]] [[blood vessels]]) | ||
===Cold agglutinins=== | ===Cold agglutinins=== | ||
*[[Cold agglutinins]] are [[antibodies]] that attack and kill [[red blood cells]], especially at cooler temperatures. | *[[Cold agglutinins]] are [[antibodies]] that [[Attack rate|attack]] and kill [[red blood cells]], especially at cooler [[temperatures]]. | ||
*These dead cells can then build up and block [[blood vessels]]. | *These [[Dead body|dead]] [[Cells (biology)|cells]] can then [[Building biology|build]] up and [[Blockhead|block]] [[blood vessels]]. | ||
*A blood test can be used to detect these [[antibodies]]. | *A [[blood test]] can be used to [[Detection theory|detect]] these [[antibodies]]. | ||
===Beta-2 microglobulin (β2M)=== | ===Beta-2 microglobulin (β2M)=== | ||
*This test measures another [[protein]] made by the [[cancer cells]] in LPL. | *This [[test]] [[Measure (data warehouse)|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). | *This [[protein]] itself doesn’t [[Causes|cause]] any problems, but it’s a useful [[indicator]] of a [[Patient|patient’s]] [[prognosis]] (outlook). | ||
*High levels of β2M are linked with a worse outlook. | *High levels of β2M are [[Link|linked]] with a worse outlook. | ||
===Urinanalysis=== | ===Urinanalysis=== | ||
*[[Proteinuria]] | *[[Proteinuria]] | ||
===Hepatitis Serology=== | ===Hepatitis 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 [[Treatment Planning|planned treatment]] includes [[rituximab]]. | ||
===Antibody titers in patients with peripheral neuropathy=== | ===Antibody titers in patients with peripheral neuropathy=== | ||
*Anti-[[myelin]]-associated [[glycoprotein]] | *Anti-[[myelin]]-[[Association (statistics)|associated]] [[glycoprotein]] | ||
*Anti-[[ganglioside]] M1 | *Anti-[[ganglioside]] M1 | ||
*Anti-[[sulfatide]] [[IgM]] [[antibodies]] | *Anti-[[sulfatide]] [[IgM]] [[antibodies]] | ||
Revision as of 22:45, 14 August 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
Laboratory findings consistent with the diagnosis of lymphoplasmacytic lymphoma include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.
Laboratory Findings
- LPL 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
- Elevated lactate dehydrogenase (LDH):[2]
- Level indicates the extent of the disease
- Elevated urea and creatinine
- Electrolyte abnormalities
- Elevated erythrocyte sedimentation rate (ESR)
- Elevated uric acid levels
- Positive Rheumatoid factor
- Positive cryoglobulins
- Positive direct anti-globulin test
- Positive cold agglutinin titre
- 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
- Prolonged prothrombin time
- Prolonged activated partial thromboplastin time
- Prolonged thrombin time
- Abnormalities related to fibrinogen levels
Mutational analysis
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
Hepatitis 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.