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
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ASD (Atrial Septal Defect) Wide, Fixed split S2 (in contrast to the normal variation in…
Mixed apneas are characterized by absent respiratory effort and airflow in the first section of…
Although rare, the differential diagnosis of hypoventilation and hypercapnia respiratory failure includes hypothyroidism. It is…
B-type natriuretic peptide (BNP) is a hormone created in response to cardiac wall stretch due…
A common finding described on computed tomography (CT) imaging. A disease with a peribronchovascular distribution…
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