1	One Step Further Waldenstrom=s Macroglobulinemia OSF - 10 Pages 239 & 241
2	Waldenstrom=s - 2 Classification: ea monoclonal gammopathy with malignant lymphoproliferation Monoclonal gammopathies: euncontrolled proliferation of a single clone or line of plasma cells ealso called Aplasma cell dyscrasia@ eplasma cell clone produces a homogenous monoclonal protein (M-protein) ein the case of Waldenstrom=s the clone produces a homogenous monoclonal protein of IgM class immunoglobulins
3	Waldenstrom=s - 3 Mechanism of Disease: ecause unknown egenetic predisposition may play a role emainly seen in older individuals epresents with the following features: Žmalignant proliferation of B cell line Žincreased plasma cell population Žhigh levels of IgM produced Žweakness, fatigue, nose & gum bleeds, and GI bleeds leads to anemia Žincreased infections Žweight loss Žincreased blood viscosity Žmay develop neurological and cardiac problems
4	Waldenstrom=s - 4 Laboratory Findings: epresence of M-protein on serum electrophoresis eserum & urine characterization of M-protein using: Žimmunofixation test (IFE) - one of choice Žimmunoelectrophoresis test (IEP) equantification of serum IgM levels using: Žnephelometry procedures eM-protein of Waldenstrom=s may be: Žin serum: wIgM heavy chains weither kappa or lambda light chains Žin urine: weither kappa or lambda light chains wfree light chains are called ABence-Jones proteins@
5	Waldenstrom=s - 5 Testing Protocol: ŽScreening tests Serum Protein Electrophoresis (SPEP) monoclonal bands present? NO no monoclonal gammopathy present YES Perform confirmatory testing to next slide
6	Waldenstrom=s - 6 Testing Protocol: ŽConfirmatory tests Urine and serum specimens CHARACTERIZATION OF MONOCLONAL BAND QUANTIFICATION OF IMMUNOGLOBULINS Serum IFE ID type of heavy chains and light chains Urine IFE Confirm Bence-Jones protein Serum Neph determine conc. of Ig=s Urine Neph determine conc. of light chains
7	End of Waldenstrom=s