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Updated: Nov 27 2019

Waldenstrom Macroglobulinemia

  • 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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