This patients 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 patients IgM titer is relatively low, so there is no reason to suspect hyperviscosity as the cause of this patients 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 patients Raynauds. The patients older age, female gender, lack of smoking history, and presence of Raynauds phenomenon without claudication or digit ulcers effectively rule out thromboangiitis obliterans.
- Type I cryoglobulinemia.
5. Tedeschi A, Barate C, Minola E, Morra E. Cryoglobulinemia. Blood Rev 2007;21:183-200.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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Updated 6/20/2008 nvf