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Hematology

Waldenstrom's macroglobulinemia

Waldenstrom’s macroglobulinemia WM

Dutcher bodiesDutcher body

  • Facts:
    Clonal disorder of B cells malignant monoclonal gammopathy

    Chronic, indolent disease of the elderly
  • History / PE:
    History of MGUS precursor

    Lethargy, fatigue, night sweats

    Raynaud’s pnenomenon (from cryoglobulinemia )

    Neurologic problems (AMS, peripheral neuropathy)
  • Diagnosis:
    Elevated ESR, uric acid, LDH, and alkaline phosphatase

    Abnormal plasma cells with Dutcher bodies

    IgM spike on electrophoresis
  • Treatment:
    Plasmaphersis

    Chemotherapy
  • Complications:
    Hyperviscosity syndrome secondary to elevated IgM (eg. retinal vein engorgement)
  • Associated With:
    Amyloidosis

    Cold agglutination disease (autoimmune hemolytic anemia )
  • Differential Diagnosis:
    Multiple myeloma (IgG or IgA, hyperviscosity syndromes rare)

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