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


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.

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

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