Lymphoplasmacytic lymphoma laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]
Overview
Laboratory findings consistent with the diagnosis of lymphoplasmacytic lymphoma include any cytopenia, lymphocytosis, monocytosis, elevated levels of LDH, Beta-2 microglobulin, uric acid, and urea & creatinine, elevated ESR, hypercalcemia, hyponatremia, positive rheumatoid factor, positive cryoglobulins, positive direct anti-globulin test, positive cold agglutinin titre, proteinuria, prolonged bleeding time, prolonged prothrombin time, prolonged activated partial thromboplastin time, prolonged thrombin time and peripheral smear shows plasmacytoid lymphocytes, normocytic normochromic red blood cells and rouleaux formation.
Laboratory Findings
- LPL is mostly suspected when a patient has low blood counts and/or high levels of unusual protein levels on blood tests.
- Usually after that, a blood test called serum protein electrophoresis is ordered to find out what type of protein is there.
- Mostly, only after these tests are done that a biopsy of either the bone marrow or a lymph node is considered to confirm the LPL diagnosis.
- Laboratory findings consistent with the diagnosis of lymphoplasmacytic lymphoma include:[1]
Complete blood count
- Anemia:
- Seen in 40% of newly diagnosed patients and in 80% of symptomatic patients with lymphoplasmacytic lymphoma
- Multi-factorial causes including: decreased RBC synthesis due to bone marrow infiltration, iron deficiency due to gastrointestinal bleeding, and chronic inflammation
- Thrombocytopenia:
- Due to bone marrow infiltration
- Neutropenia:
- Due to bone marrow infiltration
- Lymphocytosis
- Monocytosis
Peripheral smear
Chemistry Lab tests
- Elevated lactate dehydrogenase (LDH):[2]
- Level indicates the extent of the disease
- Elevated urea and creatinine
- Electrolyte abnormalities
- Elevated erythrocyte sedimentation rate (ESR)
- Elevated uric acid levels
- Positive rheumatoid factor
- Positive cryoglobulins
- Positive direct anti-globulin test
- Positive cold agglutinin titre
- Elevated beta-2-microglobulin in proportion to tumor mass
- Needed to evaluate prognosis
Platelet function test and blood coagulation studies
- Prolonged bleeding time[3]
- Possibly due to interaction between platelet membrane glycoproteins and IgM paraprotein
- Prolonged prothrombin time
- Prolonged activated partial thromboplastin time
- Prolonged thrombin time
- Abnormalities related to fibrinogen levels
Mutational analysis
- MYD88 gene mutation has been found in more than 90% of patients with lymphoplasmacytic lymphoma[4][5]
Cryocrit
- This test measures the blood levels of cryoglobulins (proteins that clump together in cool temperatures and can block blood vessels)
Cold agglutinins
- Cold agglutinins are antibodies that attack and kill red blood cells, especially at cooler temperatures.
- These dead cells can then build up and block blood vessels.
- A blood test can be used to detect these antibodies.
Beta-2 microglobulin (β2M)
- This test measures another protein made by the cancer cells in LPL.[6][7]
- This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis (outlook).
- High levels of β2M are linked with a worse outlook.
Urinalysis
Hepatitis Serology
- Hepatitis C serology should be obtained for patients with cryoglobulinemia.
- Hepatitis B serology should be obtained for patients whose planned treatment includes rituximab.
Antibody titers in patients with peripheral neuropathy
- Anti-myelin-associated glycoprotein[8][9][10]
- Anti-ganglioside M1
- Anti-sulfatide IgM antibodies
References
- ↑ García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A; et al. (2001). "Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases". Br J Haematol. 115 (3): 575–82. PMID 11736938.
- ↑ Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA; et al. (2009). "Screening panels for detection of monoclonal gammopathies". Clin Chem. 55 (8): 1517–22. doi:10.1373/clinchem.2009.126664. PMC 3773468. PMID 19520758.
- ↑ Penny R, Castaldi PA, Whitsed HM (1971). "Inflammation and haemostasis in paraproteinaemias". Br J Haematol. 20 (1): 35–44. PMID 4924493.
- ↑ Xu L, Hunter ZR, Yang G, Zhou Y, Cao Y, Liu X; et al. (2013). "MYD88 L265P in Waldenström macroglobulinemia, immunoglobulin M monoclonal gammopathy, and other B-cell lymphoproliferative disorders using conventional and quantitative allele-specific polymerase chain reaction". Blood. 121 (11): 2051–8. doi:10.1182/blood-2012-09-454355. PMC 3596964. PMID 23321251.
- ↑ Shin SY, Lee ST, Kim HY, Park CH, Kim HJ, Kim JW; et al. (2016). "Detection of MYD88 L265P in patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia and other B-cell non-Hodgkin lymphomas". Blood Res. 51 (3): 181–186. doi:10.5045/br.2016.51.3.181. PMC 5054250. PMID 27722129.
- ↑ Yoo C, Yoon DH, Suh C (2014). "Serum beta-2 microglobulin in malignant lymphomas: an old but powerful prognostic factor". Blood Res. 49 (3): 148–53. doi:10.5045/br.2014.49.3.148. PMC 4188779. PMID 25325033.
- ↑ Peterson PA, Cunningham BA, Berggård I, Edelman GM (1972). "2 -Microglobulin--a free immunoglobulin domain". Proc Natl Acad Sci U S A. 69 (7): 1697–701. doi:10.1073/pnas.69.7.1697. PMC 426781. PMID 4558655.
- ↑ Klein CJ, Moon JS, Mauermann ML, Zeldenrust SR, Wu Y, Dispenzieri A; et al. (2011). "The neuropathies of Waldenström's macroglobulinemia (WM) and IgM-MGUS". Can J Neurol Sci. 38 (2): 289–95. doi:10.1017/s0317167100011483. PMC 3901797. PMID 21320835.
- ↑ Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T; et al. (2006). "Peripheral neuropathies in Waldenström's macroglobulinaemia". J Neurol Neurosurg Psychiatry. 77 (2): 224–8. doi:10.1136/jnnp.2005.071175. PMC 2077569. PMID 16421127.
- ↑ Baldini L, Nobile-Orazio E, Guffanti A, Barbieri S, Carpo M, Cro L; et al. (1994). "Peripheral neuropathy in IgM monoclonal gammopathy and Wäldenstrom's macroglobulinemia: a frequent complication in elderly males with low MAG-reactive serum monoclonal component". Am J Hematol. 45 (1): 25–31. doi:10.1002/ajh.2830450105. PMID 7504399.