Waldenstrom’s macroglobulinemia WM

• 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)