How I treat cryoglobulinemia

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How I treat cryoglobulinemia by Eli Muchtar, Hila Magen, and Morie A. Gertz Blood Volume 129(3):289-298 January 19, 2017 ©2017 by American Society of Hematology

Schematic illustration of vascular occlusion in type I cryoglobulinemia, demonstrating glomerular intracapillary thrombi. Schematic illustration of vascular occlusion in type I cryoglobulinemia, demonstrating glomerular intracapillary thrombi. Eli Muchtar et al. Blood 2017;129:289-298 ©2017 by American Society of Hematology

Skin necrosis in cryoglobulinemia. Skin necrosis in cryoglobulinemia. (A) Three skin ulcers at the anterolateral dorsum of the left foot in a patient with newly diagnosed WM-associated mixed cryoglobulinemia. Note that the 2 large ulcers are full skin thickness with minimal surrounding inflammatory response and no tendon or bone exposure. Prophylactic antibiotics were initiated to prevent serious infection. (B) The ulcers healed within 3 months from initiation of definitive therapy for WM. Eli Muchtar et al. Blood 2017;129:289-298 ©2017 by American Society of Hematology

Cryoglobulinemic glomerulonephritis. Cryoglobulinemic glomerulonephritis. The glomerulus shows global occlusion of peripheral capillary lumina by numerous infiltrating monocytes. Segmental intracapillary pink-staining immune thrombi (arrows), likely representing cryoglobulin deposits, are seen. There is widespread duplication of the glomerular basement membrane with associated cellular interposition (silver stain). Original magnification ×400. Photo courtesy of Samih Nasr, Mayo Clinic, Rochester, MN. Eli Muchtar et al. Blood 2017;129:289-298 ©2017 by American Society of Hematology

Management algorithm for non-infectious mixed cryoglobulinemia. Management algorithm for non-infectious mixed cryoglobulinemia. CNS, central nervous system; CTX, cyclophosphamide; GN, glomerulonephritis; NSAIDS, nonsteroidal anti-inflammatory drugs; RPGN, rapidly progressive glomerulonephritis. Eli Muchtar et al. Blood 2017;129:289-298 ©2017 by American Society of Hematology

Management algorithm for infectious mixed cryoglobulinemia. Eli Muchtar et al. Blood 2017;129:289-298 ©2017 by American Society of Hematology