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]]. | ||
* 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 [[Test|tests]] are done that a [[biopsy]] of either the [[bone marrow]] or a [[lymph node]] is considered to confirm the | * 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 WM [[diagnosis]]. | ||
*[[Laboratory]] findings consistent with the [[diagnosis]] of [[ | *[[Laboratory]] findings consistent with the [[diagnosis]] of [[Waldenström's macroglobulinemia|Waldenstrom's 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 [[New|newly]] [[Diagnose|diagnosed]] [[patients]] and in 80% of [[symptomatic]] [[patients]] with [[ | **Seen in 40% of [[New|newly]] [[Diagnose|diagnosed]] [[patients]] and in 80% of [[symptomatic]] [[patients]] with [[Waldenström's macroglobulinemia|Waldenstrom'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]]: | ||
| Line 44: | Line 44: | ||
===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]] | ||
| Line 51: | Line 51: | ||
===Mutational analysis=== | ===Mutational analysis=== | ||
*'''[[MYD88]]''' [[gene]] [[mutation]] has been found in more than 90% of [[patients]] with [[ | *'''[[MYD88]]''' [[gene]] [[mutation]] has been found in more than 90% of [[patients]] with [[Waldenström's macroglobulinemia|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]] [[Measure (mathematics)|measures]] the [[blood]] levels of [[cryoglobulins]] ([[proteins]] that clump together in cool [[temperatures]] and can [[Blockhead|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]]) | ||
| Line 60: | Line 60: | ||
===Beta-2 microglobulin (β2M)=== | ===Beta-2 microglobulin (β2M)=== | ||
*This [[test]] [[Measure (data warehouse)|measures]] another [[protein]] made by the [[cancer cells]] in | *This [[test]] [[Measure (data warehouse)|measures]] another [[protein]] made by the [[cancer cells]] in WM. | ||
*This [[protein]] itself doesn’t [[Causes|cause]] any problems, but it’s a useful [[indicator]] of a [[Patient|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 [[Link|linked]] with a worse outlook. | *High levels of β2M are [[Link|linked]] with a worse outlook. | ||
Revision as of 01:47, 15 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], Roukoz A. Karam, M.D.[3], Mirdula Sharma, MBBS [4]; ; Grammar Reviewer: Natalie Harpenau, B.S.[5]
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.
- Mostly, only 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 Waldenstrom's macroglobulinemia include:[1]
Complete blood count
- Anemia:
- Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenstrom'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
- 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
- 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 (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.