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Hematology


Answer 4
  1. Type I cryoglobulinemia. This patient’s cold-related vaso-occlusive symptoms and the presence of a monoclonal IgM strongly suggest cryoglobulinemia. Type I cryoglobulins can be either monoclonal IgG or IgM and are commonly associated with lymphoproliferative disorders, and occult lymphoma needs to be considered even in the absence of palpable adenopathy or hepatosplenomegaly. The patient’s IgM titer is relatively low, so there is no reason to suspect hyperviscosity as the cause of this patient’s symptoms. Type II cryoglobulins, often seen in chronic hepatitis C infection, are IgM proteins with RF-like factor activity and immunoreactivity against polyclonal IgG. The negative RF test and negative viral hepatitis panel in this patient indicate that type I cryoglobulinemia is more likely.5 The negative ANA and RF tests essentially rule out a mixed connective tissue disorder as the underlying cause of this patient’s Raynaud’s. The patient’s older age, female gender, lack of smoking history, and presence of Raynaud’s phenomenon without claudication or digit ulcers effectively rule out thromboangiitis obliterans.

    REFERENCES
    5. Tedeschi A, Barate C, Minola E, Morra E. Cryoglobulinemia. Blood Rev 2007;21:183-200.

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