Review of cryoglobulinemia: diagnosis and management

Bottom line:  Cryoglobulinemia refers to the presence in the blood of cryoglobulins, immunoglobulins that precipitate in vitro at temperatures less than 37°C and redissolve after rewarming; normal serum proteins remain in solution even at cold temperatures.  Mean age of onset for all types of cryoglobulinemia is around 50 years.  Many patients are asymptomatic, but damage is caused mainly by either vascular hyperviscosity or by immune-mediated mechanisms, such as vasculitis.

For details
Ramos-Casals M, et al.  The cryoglobulinaemias.  Lancet. 2012; 379:348-60.
Review of all types of cryoglobulinemia. Discusses causes and pathophysiology, as well as diagnosis. See Panel 1 (p. 353) for summary of diagnostic tests. States that most patients are diagnosed by presence of organ involvement, such as skin or kidney, and presences of circulating cryoglobulins.

Iannuzzella F, et al. Management of Hepatitis C Virus-related Mixed Cryoglobulinemia. Am J Med. 2010; 123(5):400-408.
Type II cryoglobulinemia is associated with hepatitis C infection.  This review cites prevalence of HCV in type II cryoglobulinemia as 30-100%.  It also describes clinical manifestations, diagnosis and treatment of type II.

Type II Cryoglobulinemia.  In:  Dynamed.  Summarizes evidence for diagnostic and therapeutic management.   NSAIDs for mild cases, corticosteroids and cytotoxic drugs for cases involving visceral organs.  This summary also reviews evidence for interferon alpha and plasmapheresis.


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Clinical Informationist at EUH Branch Library
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