Clinical manifestations caused by monoclonal IgM (From Merlini39 ).
| Properties of the Monoclonal IgM . | Resulting Condition . | Clinical Manifestations . |
|---|---|---|
| Abbreviations: GI, gastrointestinal; MAG, myelin-associated glycoprotein; RBC, red blood cell. | ||
| Physicochemical | ||
| Intrinsic viscosity | Hyperviscosity syndrome | Fatigue, headache, blurred vision, easy mucosal bleeding, impaired mentation up to coma |
| Precipitation on cooling | Cryoglobulinemia type I | Raynaud’s phenomenon, acrocyanosis, necrosis, ulcers, purpura, cold urticaria |
| Protein-protein interaction | Hemostatic abnormalities | Bleeding diathesis: bruising, purpura, mucosal bleeding; rarely, brain hemorrhages |
| Antibody activity versus: | ||
| Nerve constituents | Polyneuropathies | Anti-MAG-related: symmetric, distal, progressive, sensorimotor neuropathy, ataxic gait, bilateral foot drop |
IgM with other specificities:
| ||
| IgG | Cryoglobulinemia type II | Weakness, purpura, arthralgias, proteinuria, renal failure, progressive, symmetric distal sensorimotor neuropathy combined with mononeuropathies (e.g., foot or wrist drop) |
| RBC antigens | Cold agglutinin hemolytic anemia | Mild, chronic hemolytic anemia exacerbated after cold exposure; Raynaud’s phenomenon, acrocyanosis and livedo reticularis |
| Tendency to deposit into tissues | ||
| As amorphous aggregates in skin, GI tract, kidney | Specific organ dysfunction | Skin: bullous skin disease, papules on extremities GI: diarrhea, malabsorption, bleeding Kidney: mild, reversible proteinuria, mostly asymptomatic |
| As amyloid fibrils (light chains) | AL amyloidosis | Fatigue, weight loss, periorbital purpura, edema, hepatomegaly, macroglossia Dysfunction of organs involved: kidneys, heart, liver, peripheral sensory and autonomic neuropathies |
| Properties of the Monoclonal IgM . | Resulting Condition . | Clinical Manifestations . |
|---|---|---|
| Abbreviations: GI, gastrointestinal; MAG, myelin-associated glycoprotein; RBC, red blood cell. | ||
| Physicochemical | ||
| Intrinsic viscosity | Hyperviscosity syndrome | Fatigue, headache, blurred vision, easy mucosal bleeding, impaired mentation up to coma |
| Precipitation on cooling | Cryoglobulinemia type I | Raynaud’s phenomenon, acrocyanosis, necrosis, ulcers, purpura, cold urticaria |
| Protein-protein interaction | Hemostatic abnormalities | Bleeding diathesis: bruising, purpura, mucosal bleeding; rarely, brain hemorrhages |
| Antibody activity versus: | ||
| Nerve constituents | Polyneuropathies | Anti-MAG-related: symmetric, distal, progressive, sensorimotor neuropathy, ataxic gait, bilateral foot drop |
IgM with other specificities:
| ||
| IgG | Cryoglobulinemia type II | Weakness, purpura, arthralgias, proteinuria, renal failure, progressive, symmetric distal sensorimotor neuropathy combined with mononeuropathies (e.g., foot or wrist drop) |
| RBC antigens | Cold agglutinin hemolytic anemia | Mild, chronic hemolytic anemia exacerbated after cold exposure; Raynaud’s phenomenon, acrocyanosis and livedo reticularis |
| Tendency to deposit into tissues | ||
| As amorphous aggregates in skin, GI tract, kidney | Specific organ dysfunction | Skin: bullous skin disease, papules on extremities GI: diarrhea, malabsorption, bleeding Kidney: mild, reversible proteinuria, mostly asymptomatic |
| As amyloid fibrils (light chains) | AL amyloidosis | Fatigue, weight loss, periorbital purpura, edema, hepatomegaly, macroglossia Dysfunction of organs involved: kidneys, heart, liver, peripheral sensory and autonomic neuropathies |