cryoglobulinaemia

Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One third of cases are idiopathic

Three types
type I (25%): monoclonal
type II (25%): mixed monoclonal and polyclonal: usually with RF
type III (50%): polyclonal: usually with RF

Type I
monoclonal - IgG or IgM
associations: multiple myeloma, Waldenstr´┐Żm macroglobulinaemia

Type II
mixed monoclonal and polyclonal: usually with RF
associations: hepatitis C, RA, Sjogren's, lymphoma

Type III
polyclonal: usually with RF
associations: RA, Sjogren's

Symptoms (if present in high concentrations)
Raynaud's only seen in type I
cutaneous: vascular purpura, distal ulceration, ulceration
arthralgia
renal involvement (diffuse glomerulonephritis)

Tests
low complement (esp. C4)
high ESR

Treatment
immunosuppression
plasmapheresis

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