Updated: 11/27/2019

Waldenstrom Macroglobulinemia

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Introduction
  • B cell lymphoma with monoclonal IgM production
    • type of non-Hodgkin lymphoma
Presentation
  • Presents in older individuals
  • Symptoms 
    • constitutional symptoms
      • fatigue and headache
    • generalized lymphadenopathy
    • petechial bleeding
      • IgM disrupts platelet aggregation
    • anemia
    • Raynaud phenomenon
    • sequelae of blood hyperviscosity and cold agglutinins
      • retinal hemorrhage
      • stroke
      • decreased renal function
Evaluation
  • Labs
    • ↑ ESR, LDH, alkaline phosphatase, and uric acid
  • Bone marrow biopsy
    • abnormal plasma cells 
      • contains intranuclear aggregations of IgM (Dutcher bodies)
  • Serum protein electrophoresis 
    • M spike = IgM 
      • unlike multiple myeloma which is IgA/G
  • Urine
    • Bence Jones proteins will be present
      • Ig light chains
    • urine dipstick will be negative for protein as it detects only albumin
  • Imaging
    • no lytic bone lesions
Treatment
  • Symptomatic only
    • rituximab
  • Plasmapheresis when hyperviscosity is present
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