Waldenström Macroglobulinemia

Diagnosis

The average age of diagnosis of Waldenström macroglobulinemia is 63. One in 20 patients complains of numbness or tingling in the hands or feet. One in five has liver enlargement. One in six will has spleen enlargement, which usually is asymptomatic and does not require treatment. Enlarged lymph glands are seen in approximately one in six.

Abnormal blood proteins can be found in healthy, asymptomatic adults. They are present in approximately one in 100 adults over age 50 and one in 30 over age 70. Approximately 20 percent of abnormal blood proteins seen in people are of the IgM type that can be associated with Waldenström macroglobulinemia. The majority of people who have an IgM protein in their blood have no associated serious disorder. The presence of IgM is frequently an incidental finding detected during a thorough physical examination and laboratory studies. The presence of an abnormal protein without any underlying illness is referred to as monoclonal gammopathy of undetermined significance (MGUS).

The presence of an IgM protein is a characteristic feature of Waldenström. Not all people who have an IgM protein in their blood require immediate treatment. Mayo Clinic doctors will look for anemia with symptoms such as fatigue and loss of stamina or energy. Doctors may also ask questions about numbness or tingling in hands or feet, breathing problems, or nose or gum bleeding. Many people who have no symptoms can be watched for many years. Even people who have high levels of the IgM protein may not have symptoms and may not need treatment.

Confirming the diagnosis of Waldenström macroglobulinemia requires examination of the bone marrow for abnormal lymphocytes. During this test, a small sample of the bone marrow is removed under local anesthesia or sedation. Specialized blood and urine tests are done to detect the macroglobulin protein.

The most common laboratory finding in Waldenström macroglobulinemia is anemia with a blood hemoglobin level of less than 10 (normal is greater than 12 in women and greater than 13 in men). A 24-hour urine protein count may be done to determine if abnormal proteins are in the urine. Occasionally, the lungs can be involved in Waldenström macroglobulinemia, either with enlarged lymph glands between lungs or growths of the lymphocytes in the lung tissue. Generally, lung involvement does not cause symptoms. People with Waldenström macroglobulinemia usually have symptoms of numbness and tingling in their hands and feet, due to nerve damage caused by the abnormal protein in their blood.