Waldenström's macroglobulinemia other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]
Overview
In waldenström's macroglobulinemia, serum and urine protein electrophoresis is used as the screening test, while serum and urine immunofixation is used as the confirmatory test.[1] Patients with waldenström's macroglobulinemia should have nerve conduction study, antimyelin associated glycoprotein serology[2], and fundoscopy done.[3] Bone marrow aspirate is frequently hypocellular in waldenström's macroglobulinemia. Biopsy specimen is usually hypercellular and infiltrated with lymphoid and plasmacytoid cells. Dutcher bodies (PAS positive Intranuclear vacuoles containing IgM monoclonal protein) are characteristic feature of waldenström's macroglobulinemia.[4]
Serum and urine protein electrophoresis
- Screening test for monoclonal protein[1]
- The key diagnostic criterion for waldenström's macroglobulinemia is the detection of monoclonal IgM protein.
- Sharp, narrow spike or dense band of monoclonal IgM
Serum and urine immunofixation
- Confirmatory test for presence of monoclonal proteins and to determine it's subtype.
- The quantitative IgM levels observed should be 2 or 3g/dL more than that found in the serum protein electrophoretic spike.
- Characterize heavy chain and light chain immunoglobulins[5]
Findings in Nerve Conduction Study
- Patients with waldenström's macroglobulinemia show demyelination with sensory involvement more than motor.[2]
Findings in Serology
- Waldenström's macroglobulinemia shows antimyelin associated glycoprotein.[2]
Findings in Fundoscopy
- Waldenström's macroglobulinemia may show enlarged veins in the retina.[3]
Findings in Bone Marrow Aspirate
- Bone marrow aspirate is frequently hypocellular.[4]
Findings in Bone Marrow Biopsy
- Biopsy specimen is usually hypercellular and infiltrated with lymphoid and plasmacytoid cells.
- Dutcher bodies (PAS positive Intranuclear vacuoles containing IgM monoclonal protein) are the characteristic features of waldenström's macroglobulinemia.
- Three patterns of marrow involvement are described, as follows:
- Lymphoplasmacytoid cells (lymphoplasmacytic and small lymphocytes) in a nodular pattern
- Lymphoplasmacytic cells (small lymphocytes, mature plasma cells, mast cells) in an interstitial/nodular pattern
- A polymorphous infiltrate (small lymphocytes, plasma cells, plasmacytoid cells, immunoblasts with mitotic figures)
References
- ↑ 1.0 1.1 Riches PG, Sheldon J, Smith AM, Hobbs JR (1991). "Overestimation of monoclonal immunoglobulin by immunochemical methods". Ann. Clin. Biochem. 28 ( Pt 3): 253–9. PMID 1872571.
- ↑ 2.0 2.1 2.2 Nobile-Orazio E, Marmiroli P, Baldini L, Spagnol G, Barbieri S, Moggio M, Polli N, Polli E, Scarlato G (1987). "Peripheral neuropathy in macroglobulinemia: incidence and antigen-specificity of M proteins". Neurology. 37 (9): 1506–14. PMID 2442666.
- ↑ 3.0 3.1 Waldenström's macroglobulinemia. MedlinePlus (2015)https://www.nlm.nih.gov/medlineplus/ency/article/000588.htm Accessed on November 16, 2015
- ↑ 4.0 4.1 Agarwal A, Ghobrial IM (2013). "The bone marrow microenvironment in Waldenström macroglobulinemia". Clin Lymphoma Myeloma Leuk. 13 (2): 218–21. doi:10.1016/j.clml.2013.02.006. PMC 3654400. PMID 23490994.
- ↑ Waldenström's macroglobulinemia. SCIELO (2015)http://www.scielo.br/scielo.php?pid=S0104-42302014000500490&script=sci_arttextAccessed on November 10, 2015