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ALL / Haematology

Cryoglobulinaemia

Cryoglobulinaemia

Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One-third of cases are idiopathic

Three types
  • type I (25%):
    • monoclonal - IgG or IgM
    • associations: multiple myeloma, Waldenstrom macroglobulinaemia
  • type II (25%)
    • mixed monoclonal and polyclonal: usually with rheumatoid factor
    • associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma
  • type III (50%)
    • polyclonal: usually with rheumatoid factor
    • associations: rheumatoid arthritis, Sjogren's

Possible features
  • Raynaud's only seen in type I
  • cutaneous
    • vascular purpura
    • distal ulceration
    • ulceration
  • arthralgia
  • renal involvement
    • diffuse glomerulonephritis

Investigations
  • low complement (esp. C4)
  • high ESR

Management
  • treatment of underlying condition e.g. hepatitis C
  • immunosuppression
  • plasmapheresis
+PassMedicine Notes

Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One-third of cases are idiopathic

Three types
  • type I (25%):
    • monoclonal - IgG or IgM
    • associations: multiple myeloma, Waldenstrom macroglobulinaemia
  • type II (25%)
    • mixed monoclonal and polyclonal: usually with rheumatoid factor
    • associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma
  • type III (50%)
    • polyclonal: usually with rheumatoid factor
    • associations: rheumatoid arthritis, Sjogren's
Possible features
  • Raynaud's only seen in type I
  • cutaneous
    • vascular purpura
    • distal ulceration
    • ulceration
  • arthralgia
  • renal involvement
    • diffuse glomerulonephritis
Investigations
  • low complement (esp. C4)
  • high ESR
Management
  • treatment of underlying condition e.g. hepatitis C
  • immunosuppression
  • plasmapheresis


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