Waldenström's macroglobulinemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]Roukoz A. Karam, M.D.[3]

Overview

Laboratory findings consistent with the diagnosis of Waldenström's macroglobulinemia include any cytopenia, elevated LDH, and elevated Beta-2 microglobulin.

Laboratory Findings

Complete blood count

• Anemia
  • Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with Waldenström's macroglobulinemia.
  • The cause of anemia in Waldenström's macroglobulinemia is multifactorial:
    • Decreased RBC synthesis due to bone marrow infiltration
    • Iron deficiency due to gastrointestinal bleeding
    • Chronic inflammation
• Thrombocytopenia
• Neutropenia
• Lymphocytosis
• Monocytosis

Peripheral smear

• Plasmacytoid lymphocytes
• Normocytic normochromic red blood cells
• Rouleaux formation

Serum and urine protein electrophoresis

• Screening test for Waldenström macroglobulinemia
• Detection of M spike

Serum and urine immunofixation

• Confirmatory test for waldenström's macroglobulinemia

• Determines the IgM type of immunoglobulin

Chemistry lab tests

• Elevated beta-2-microglobulin in proportion to tumor mass
• Elevated lactate dehydrogenase
• Elevated creatinine
• Electrolyte abnormalities:

• Hypercalcemia(4%)

• Elevated erythrocyte sedimentation rate and uric acid
• Total protein levels
• Albumin-to-globulin ratio
• Rheumatoid factor, cryoglobulins, direct anti-globulin test, and cold agglutinin titre results can be positive.
• Coagulation studies can be abnormal with elevated prothrombin time, activated partial thromboplastin time, and thrombin time.

Plasma viscosity

• Plasma viscosity should be measured in patients presenting with hyperviscosity syndrome whenever the monoclonal IgM protein spike is >4 g/dL.
• The normal plasma viscosity is 1.8 centipoise.
• Patient presents with hyperviscosity symptoms with viscosity >4 centipoise.