Diagnostic approach to confirm a suspected case of Waldenström macroglobulinemia
| 1. Serum protein electrophoresis. |
| 2. Immunofixation—to characterize the type of light and heavy chains. |
| 3. 24-Hour urine collection for protein electrophoresis—40%-80% have detectable Bence Jones proteinuria. |
| 4. Serum β2-microglobulin—for prognostic evaluation. |
| 5. Bone marrow biopsy—intratrabecular monoclonal lymphoplasmacytic infiltrate, ranging from predominantly lymphocytic to lymphoplasmacytic to overt plasma cells. |
| 6. Cytogenetic studies—optional. |
| 7. Computed tomography of the abdomen and pelvis—to detect organomegaly and lymphadenopathy. (Skeletal surveys and bone scans are not necessary in absence of symptoms, since lytic bone lesions are unusual.) |
| 8. Blood or serum viscosity—if signs and symptoms of hyperviscosity syndrome are present or IgM > 5000. |
| 1. Serum protein electrophoresis. |
| 2. Immunofixation—to characterize the type of light and heavy chains. |
| 3. 24-Hour urine collection for protein electrophoresis—40%-80% have detectable Bence Jones proteinuria. |
| 4. Serum β2-microglobulin—for prognostic evaluation. |
| 5. Bone marrow biopsy—intratrabecular monoclonal lymphoplasmacytic infiltrate, ranging from predominantly lymphocytic to lymphoplasmacytic to overt plasma cells. |
| 6. Cytogenetic studies—optional. |
| 7. Computed tomography of the abdomen and pelvis—to detect organomegaly and lymphadenopathy. (Skeletal surveys and bone scans are not necessary in absence of symptoms, since lytic bone lesions are unusual.) |
| 8. Blood or serum viscosity—if signs and symptoms of hyperviscosity syndrome are present or IgM > 5000. |