Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Hematology


Answer 1
  1. Close serial monitoring. This patient almost certainly has IgM monoclonal gammopathy of uncertain significance (MGUS), defined as the presence of monoclonal IgM (< 3 g/dL); bone marrow with less than 10% involvement by CD10-, CD20+, CD23-, CD138- lymphoplasmacytic lymphocytes; and no evidence of end-organ damage (eg, anemia, hepatosplenomegaly, serum hyperviscosity, B symptoms [fever, weight loss, night sweats], adenopathy). Patients with IgM MGUS have an approximate 46-fold increased risk of developing WM compared with the general population.1 Although a bone marrow biopsy or CT scan may reveal greater than 10% marrow infiltration or modest enlargement of lymph nodes or the spleen, this would not change management if symptoms are absent. Patients with asymptomatic (“smoldering”) WM may be followed for years in some cases without intervention. In patients with significant symptoms, systemic chemotherapy would not be started until the diagnosis was confirmed by immunohistologic testing or flow cytometry.

    REFERENCES
    1.  Fonseca R, Hayman S. Waldenström macroglobulinaemia. Br J Haematol 2007;138:700-20.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 6/20/2008 • nvf