| Cryoglobulinemia |
| The Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing and Allied Health (Sixth Edition) defines cryoglobulinemia as "the presence of cryoglobulins in the blood, associated with a variety of clinical manifestations including Raynaud's phenomenon, vascular purpura, cold urticaria, necrosis of extremities, bleeding disorders, vasculitis, arthralgia, neurologic manifestations, hepatosplenomegaly and glomerulonephritis". Literally, the term "cryoglobulinemia" means "cold antibody in the blood" or an "abnormal protein". Approximately 1/3 to 1/2 of cases also have Hepatitis C (though this amount can vary depending on different studies). There are three types of cryoglobulins: Type I is a monoclonal antibody (one immunoglobulin---usually IgG or IgM or IgA) that does not carry a rheumatoid factor with it. Type I is most often associated with lymphoma, macroglobulinemia and multiple myeloma. With type I, complement is not activated until the cryoglobulins reach a very high amount...thus, people can be asymptomatic. Type II has the rheumatoid factor is present . Type II is polyclonal, that is, more than one immunoglobulin is present (usually IgG and IgM). Because of this structure, Type II is often called "Mixed Cryoglobulinemia". Type II is associated with lymphoproliferative diseases. Both types occur in rheumatic diseases as well as chronic infections. Cryoglobulinemia is called "essential" (or EMC)when there is no known cause found. Lab abnormalities include: markedly elevated ESR, low complement levels, elevated gammaglobulins, and a positive Rheumatoid Factor (though approximately 30% are sero-negative for RF). Because many general practioners know very little about Cryoglobulinemia, they often mistake its symptoms for Lupus. While Cryoglobulinemia and Lupus share several characteristics, an inexpensive lab test for cryoglobulins can be performed to rule out the possibility of cryoglobulinemia. Many people have been wrongly diagnosed (or have gone years without any diagnosis) because GP's in general do not order tests for cryoglobulins. |