Type 1 cryoglobulinemia is associated with all the following EXCEPT-
Cryoglobulins are antibodies directed against other immunoglobulins, and which form immune complexes that precipitate in the cold. type1 type 2 type 3 Immunoglobulin isotype and specificity Isolated monoclonal IgM paraprotein with no paicular specificity Immune complexes formed by monoclonal IgM paraprotein directed towards constant region of IgG Immune complexes formed by polyclonal IgM or IgG directed towards constant region of IgG Prevalence 25% 25% 50% Disease association Lymphoproliferative disease, especially Waldenstrom macroglobulinaemia Infection, paicularly hepatitis B and hepatitis C; lymphoproliferative disease Infection, paicularly hepatitis B and C; autoimmune disease, including rheumatoid ahritis and SLE Symptoms Hyperviscosity: Raynaud's phenomenon Acrocyanosis Retinal vessel occlusion Aerial and venous thrombosis Small-vessel vasculitis: Purpuric rash Ahralgia Cutaneous ulceration Hepatosplenomegaly Glomerulonephritis Raynaud's phenomenon Small-vessel vasculitis: Purpuric rash Ahralgia Cutaneous ulceration Hepatosplenomegaly Glomerulonephritis Raynaud's phenomenon Protein electrophoresis Monoclonal IgM paraprotein Monoclonal IgM paraprotein No monoclonal paraprotein Rheumatoid factor -ve strongly +ve +ve Complement Normal decreased c4 decreased c4 REF:DAVIDSON&;S PRINCIPLES AND PRACTICE OF MEDICINE 22nd EDITION PAGE NO 88
Hyperviscosity
Monoclonal 1gM paraprotein
Normal complement
Strongly positive rheumatoid factor
Immune system