Department of Pathology, University of Michigan, M5242B Medical Science I, 1301 Catherine St, Ann Arbor, MI 48109, USA.
Am J Clin Pathol. 2013 Mar;139(3):352-9. doi: 10.1309/AJCPBPSF0Q8EQYNM.
On the basis of anecdotal instances in which atypical laboratory findings suggested the possibility of unsuspected cryoglobulinemia, we applied predetermined criteria to determine how often such findings predict the presence of clinically significant cryoglobulinemia. The laboratory criteria are smeared M-spike (paraprotein) in agarose gel serum protein electrophoresis, precipitated protein at the serum application point of agarose electrophoresis gel, greater than 50% quantitative discrepancy between the densitometrically estimated M-spike and the relevant corresponding serum immunoglobulin isotype concentration from the same specimen, and smeared protein observed on an agarose electrophoresis immunofixation gel. Cases that fulfilled any of these criteria were prospectively collected for 2 years. Brouet types and clinical findings were determined in cases where cryoglobulins were subsequently identified and clinical data available. Among 83 patients in whom any of the above laboratory findings were identified, 52 had subsequent cryoglobulin evaluations. Fourteen of these 52 patients had cryoglobulinemia. Findings indicative of clinically significant cryoglobulinemia were present in 8 of the 10 patients in whom follow-up clinical data were available.
基于一些非典型的实验室发现提示存在未被怀疑的冷球蛋白血症的实例，我们应用预定的标准来确定这些发现预测临床显著冷球蛋白血症存在的频率。实验室标准为琼脂糖凝胶血清蛋白电泳中弥漫性 M 峰（副蛋白）、琼脂糖电泳凝胶血清加样点沉淀蛋白、用密度计估计的 M 峰与同一样本中相关对应血清免疫球蛋白同种型浓度之间大于 50%的定量差异，以及在琼脂糖电泳免疫固定凝胶上观察到弥漫性蛋白。满足这些标准中的任何一个的病例在接下来的 2 年中被前瞻性收集。在随后鉴定出冷球蛋白并获得临床数据的病例中，确定了 Brouet 类型和临床发现。在确定存在上述任何一种实验室发现的 83 名患者中，有 52 名进行了后续的冷球蛋白评估。这 52 名患者中有 14 名患有冷球蛋白血症。在有随访临床数据的 10 名患者中的 8 名患者中存在提示临床显著冷球蛋白血症的发现。
