Biologic and clinical significance of cryoglobulins
. A report of 86 cases.
Laboratory work-up showed a normal complete blood count, a negative antinuclear antibodies (ANA) titer, a negative double-stranded DNA, normal levels of inflammatory markers, and negative cryoglobulins
and cold agglutinins.
The rest of the panel was negative, including anti-dsDNA, anti-Smith antibody, cryoglobulins
, anti-RNP antibody, anti-aldolase antibody, c-ANCA, p-ANCA, ceruloplasmin, and alpha-1-antitrypsin.
The findings for serum calcium, albumin, anti-nuclear antibodies, extractable nuclear antigen panel, cryoglobulins
, complement [C.sub.3] and [C.sub.4], rheumatoid factor, antiphospholipid antibodies, protein C, and protein S were normal.
Urine examination was normal and serum cryoglobulins
were not raised.
Further investigation had been unremarkable, including negative tests for anti-centromere/anti-Scl70 antibodies, anti-neutrophil cytoplasmic antibody (ANCA), antiphospholipid antibodies, cryoglobulins
, and serology for viruses hepatitis B, C, and HIV.
Hepatitis C is likely secondary to the presence of cryoglobulins
(proteins (immunoglobulins)which occurs in blood in certain disorders).However, when 1,614 patients with hepatitis C were studied, vasculitis occurred in only 12 patients (nine with cryoglobulinemia and three without).
Hepatitis B and C, antinuclear antibody, double-stranded deoxyribonucleic acid, anti-Sjogren syndrome A and B, anti-neutrophil cytoplasmic antibody, anti-glomerular basement membrane antibody, and cryoglobulins
were all negative.
Her rheumatoid factor was repeatedly high (512 and 480 [micro]/l) with repeatedly positive serum cryoglobulins
in a qualitative assay.
Others autoantibodies with high prevalence in SS patients are rheumatoid factor, cryoglobulins
, anticentromere antibodies (ACA), autoantibodies against cyclic citrullinated peptides (anti-CCP), calreticulin, antimitochondrial antibodies (AMA), antibodies to muscarinic receptors, autoantibodies targeting carbonic anhydrase II (anti-CAII), anti-smooth muscle antibodies (ASMA) , and antinuclear antibodies (ANA) are present in the sera of 59-85% of patients .
She was found to have normal hemogram and bleeding profile and negative perinuclear antineutrophil cytoplasmic antibodies (P-ANCA), antineutrophil cytoplasmic antibodies (C-ANCA), and cryoglobulins
. Urine examination showed 2+ albumin without associated hematuria and 24-hour urinary protein was 1600 mg, for which she underwent kidney biopsy.
Up to 80 percent of patients with essential mixed cryoglobulinemia are infected with HCV, and nearly 50 percent of patients with HCV infection have low levels of circulating mixed cryoglobulins