Case 69 – part 3 – summary

During this short case we looked at serum protein electrophoresis.


This showed a band in the gamma region and immunofixation confirmed a IgM kappa paraprotein. IgM paraproteins are commonly associated with MGUS, low grade lymphoma and rarely myeloma. Typically IgM paraproteins are associated with lymphoplasmacytic lymphoma/Waldrenstrom’s macroglobulinaemia or splenic marginal zone lymphoma.


When evaluating a person with a paraprotein it is important to think of the following:

  • Lymphoma – lymphadenopathy, splenomegaly, B symptoms
  • Myeloma – bone pain, symptoms of hypercalcaemia
  • Renal failure – amyloidosis, tumour lysis, light chain deposition
  • Neuropathy
  • Cold aggultinins/haemolysis
  • Cryoglobulinaemia
  • Hyperviscosity – fundoscopy is vital to look for retinal haemorrhage
  • Infections


It would be important to consider the following investigations:

  • Biochemistry: LDH, U&E, LFT, calcium
  • Microbiology: HIV, hep B and hep C
  • Bone marrow aspirate and trephine biopsy (looking for a lymphoplasmacytic infiltrate with a null B cell phenotype)
  • Molecular analysis for MYD88 and possibly CXCR4
  • CT chest/abdomen/pelvis

This patient has hyperviscosity so treatment with steroids e.g. dexamethasone 20mg and plasma exchange is indicated. Do not give rituxumab until the IgM paraprotein has settled as there is a risk of IgM flare. Common regimes include dexamethasone, cyclophosphamide rituxumab or bendamustine ritxuimab




lease reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #TeamHaem on Twitter for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.


About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Lymphoma and tagged , , , , , , , . Bookmark the permalink.