{"id":2386,"date":"2013-09-12T13:51:43","date_gmt":"2013-09-12T13:51:43","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/cryoglobulinemias\/"},"modified":"2025-05-13T20:27:52","modified_gmt":"2025-05-13T20:27:52","slug":"cryoglobulinemias","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/cryoglobulinemias\/","title":{"rendered":"Classification and Clinico-Pathological Characteristics of Different Cryoglobulinemias"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Cryoglobulinemia is usually classified into three subgroups according to Ig composition: type I cryoglobulinemia is composed of only one isotype or subclass of immunoglobulin. Both type II and type III mixed cryoglobulins are immune complexes composed of polyclonal IgGs, the autoantigens, and mono- or polyclonal IgMs, respectively; the IgMs are the corresponding autoantibodies with rheumatoid factor (RF) activity.<br \/>\n<!--more--><br \/>\n<strong>Classification and clinico-pathological characteristics of different cryoglobulinemias<\/strong><\/p>\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"4\">\n<colgroup>\n<col width=\"64*\" \/>\n<col width=\"64*\" \/>\n<col width=\"64*\" \/>\n<col width=\"64*\" \/> <\/colgroup>\n<tbody>\n<tr valign=\"TOP\">\n<td width=\"25%\"><strong>Cryoglobulins<\/strong><\/td>\n<td width=\"25%\"><strong>Composition<\/strong><\/td>\n<td width=\"25%\"><strong>Pathological findings<\/strong><\/td>\n<td width=\"25%\"><strong>Clinical associations<\/strong><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"25%\">Type I cryoglobulinemia<\/td>\n<td width=\"25%\">monoclonal Ig, mainly IgG, or IgM, or IgA self-aggregation through Fc fragment of Ig<\/td>\n<td width=\"25%\">tissue histological alterations of underlying disorder<\/td>\n<td width=\"25%\">-lymphoproliferative disorders:<br \/>\nMM, WM, CLL, B-cell NHL<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"25%\">Type II<br \/>\nmixed cryoglobulinemia<\/td>\n<td width=\"25%\">monoclonal IgM (or IgG, or IgA) with RF activity (often cross-idiotype WA-mRF) and polyclonal Ig (mainly IgG)<\/td>\n<td width=\"25%\">-leukocytoclastic vasculitis<br \/>\n-B-lymphocyte expansion with tissue infiltrates<\/td>\n<td width=\"25%\">-infections (mainly HCV, HBV, HIV)<br \/>\n-autoimmune\/ lymphoproliferative disorders<br \/>\n-rarely &#8216;essential&#8217;<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"25%\">Type II\u2013III<br \/>\nmixed cryoglobulinemia<\/td>\n<td width=\"25%\">oligoclonal IgM RF or mixture of poly\/<br \/>\nmonoclonal IgM (often cross-idiotype WA-mRF)<\/td>\n<td width=\"25%\">-leukocytoclastic vasculitis<br \/>\n-B-lymphocyte expansion with tissue infiltrates<\/td>\n<td width=\"25%\">-infections (mainly HCV, HBV, HIV)<br \/>\n-autoimmune\/ lymphoproliferative disorders<br \/>\n-rarely &#8216;essential&#8217;<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"25%\">Type III<br \/>\nmixed cryoglobulinemia<\/td>\n<td width=\"25%\">polyclonal mixed Ig (all isotypes) with RF activity of one polyclonal component (usually IgM)<\/td>\n<td width=\"25%\">-leukocytoclastic vasculitis<br \/>\n-B-lymphocyte expansion with tissue infiltrates<\/td>\n<td width=\"25%\">-infections (mainly HCV)<br \/>\n-more often autoimmune disorders<br \/>\n-rarely &#8216;essential&#8217;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>lymphoproliferative disorders: MM (multiple myeloma), WM (Waldenstrom&#8217;s macroglobulinemia), CLL (chronic lymphocytic leukemia), B-cell NHL (B-cell non-<br \/>\nHodgkin&#8217;s lymphoma); Ig: immunoglobulin; RF: rheumatoid factor; HBV: hepatitis B virus; HCV: hepatitis C virus<\/p>\n<p><strong>Proposed criteria for the classification of mixed cryoglobulinemia (MC) patients<\/strong><\/p>\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"4\">\n<colgroup>\n<col width=\"85*\" \/>\n<col width=\"85*\" \/>\n<col width=\"85*\" \/> <\/colgroup>\n<tbody>\n<tr valign=\"TOP\">\n<td width=\"33%\"><strong>Criteria<\/strong><\/td>\n<td width=\"33%\"><strong> Major<\/strong><\/td>\n<td width=\"33%\"><strong>Minor<\/strong><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"33%\">Serological<\/td>\n<td width=\"33%\">Mixed cryoglobulins<br \/>\nLow C4<\/td>\n<td width=\"33%\">Rheumatoid factor +<br \/>\nHCV +<br \/>\nHBV +<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"33%\">Pathological<\/td>\n<td width=\"33%\">Leucocytoclastic vasculitis<\/td>\n<td width=\"33%\">Clonal B cell infiltrates (liver and\/or bone marrow)<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"33%\">Clinical<\/td>\n<td width=\"33%\">Purpura<\/td>\n<td width=\"33%\">Chronic hepatitis<br \/>\nMembrano-proliferative glomerulonephritis<br \/>\nPeripheral neuropathy<br \/>\nSkin ulcers<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>\u201cDefinite\u201d mixed cryoglobulinaemia syndrome:<\/p>\n<ol style=\"list-style-type: lower-alpha;\">\n<li>Serum mixed cryoglobulins (\u00b1low C4) + purpura + leucocytoclastic vasculitis.<\/li>\n<li>Serum mixed cryoglobulins (\u00b1low C4) + 2 minor clinical symptoms + 2 minor serological\/pathological findings.<\/li>\n<\/ol>\n<p>\u201cIncomplete\u201d or \u201cpossible\u201d mixed cryoglobulinaemia syndrome:<\/p>\n<ol style=\"list-style-type: lower-alpha;\">\n<li>Mixed cryoglobulins or low C4 + 1 minor clinical symptom + 1 minor serological \u00b1pathological findings.<\/li>\n<li>Purpura and\/or leucocytoclastic vasculitis + 1 minor clinical symptom + 1 minor serological \u00b1pathological findings.<\/li>\n<li>Two minor clinical symptoms + 2 minor serological \u00b1 pathological findings.<\/li>\n<\/ol>\n<p>\u201cEssential\u201d or \u201csecondary\u201d mixed cryoglobulinaemia:<br \/>\nAbsence or presence of well known disorders (infectious, immunological, or neoplastic) at the time of the diagnosis.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Ferri C. Mixed cryoglobulinemia. Orphanet J Rare Dis. 2008 Sep 16;3:25. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18796155\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medlne]<\/a><\/li>\n<li>Terrier B, Cacoub P. Cryoglobulinemia vasculitis: an update. Curr Opin Rheumatol. 2013 Jan;25(1):10-8. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23196322\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Sep 12, 2013.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[289],"tags":[40,952,166,167,489,1046,1045,1044,1043,1042,1047],"class_list":["post-2386","post","type-post","status-publish","format-standard","hentry","category-immunology","tag-caracteristicas","tag-characteristics","tag-clasificacion","tag-classification","tag-clinico","tag-crioglobulinemias","tag-cryoglobulinemias","tag-diferenciales","tag-different","tag-pathological","tag-patologica"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2386"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2386\/revisions"}],"predecessor-version":[{"id":9296,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2386\/revisions\/9296"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2386"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2386"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}