Cold Agglutinins => Autoimmune hemolytic anemia (AIHA) occurring around 28-31°C -> Typically IgM auto antibodies directed against red blood cells, causing clumping (agglutination) of RBCs (i.e Mycoplasma pneumoniae, CMV, EBV, infectious mononucleosis, varicella zoster virus, HIV, lymphoma, CLL, Waldenström’s)
Cryoglobulins => Insoluble immunoglobulins (also IgM/IgG) that precipitate out of serum in cold temperatures and re-dissolve upon rewarming (i.e Hepatitis C, Multiple Myeloma, lymphoma, CLL, sarcoidosis, SLE, RA)
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TYPE 1 CRYOGLOBULINS
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Monoclonal IgM. Think Myeloma/ Lymphoma. Hypervisocity, Raynauds. Digital ischemia
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TYPE 2 CRYOGLOBULINS
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Monoclonal IgM, Poly IgG. Think Infections/ Hepatitis C. Fatigue, Mylagia, Purpura
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TYPE 3 CRYOGLOBULINS
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Poly IgM, Poly IgG. Think autoimmune (i.e Sjogrens).
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TESTS
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ANA, ENA, RF (elevated in 2/3) and C3 and C4 (typically low)
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REFERENCES
Obstructive sleep apnea (OSA) is thought to lead to secondary polycythemia due to intermittent hypoxia,…
Catabolism of hemoglobin leads to the release of heme, which converts to biliverdin and then…
Tongue scalloping refers to the series of indentations along the sides of the tongue that…
Older age is recognized as a risk factor for obstructive sleep apnea.[1] But why? Suspected…
Being overweight (BMI ≥ 25 kg/m2)/Obese (BMI ≥ 30 kg/m2) is one of the most…
Nocturia is a common symptom associated with obstructive sleep apnea. [1] Img Cred: Am J…
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