Cryogelation Associated with Waldenstrom's Macroglobulinemia

 

Clinical features:

(1) The patient has a monoclonal gammopathy, usually Waldenstrom's macroglobulinemia (with monoclonal IgM).

(2) The plasma forms a gel as a blood sample cools.

(3) The gel may not disappear on reheating the specimen.

 

Differential diagnosis:

(1) plasma gelation due to a pyroglobulin (gel forms after the sample has been heated)

(2) cryogel in patients with rheumatoid arthritis (associated with plasma fibronectin)

 

If a person's blood is noted to gel in vitro:

(1) determine if the gelation occurs on cooling or warming

(2) perform serum protein immunoelecrophereis while maintaining the sample at 37°C

(3) inquire about a history of rheumatoid arthritis or other autoimmune disease