Fast Five Quiz: Waldenström Macroglobulinemia Workup

Emmanuel C. Besa, MD


February 01, 2021

Figure 1. Iliac puncture to remove bone marrow from the iliac crest.

The laboratory diagnosis of WM is made upon the identification of significant monoclonal IgM elevation and malignant cells consistent with WM. Diagnosis therefore requires monoclonal protein studies and bone marrow biopsy (with or without lymph node/involved tissue biopsy). Bone marrow examination in those with WM will show infiltration by small lymphocytes showing plasmacytic differentiation; the pattern of infiltration is generally diffuse or interstitial.

Clinical practice guidelines advise that the initial workup for WM should also include:

  • Complete blood cell (CBC) count

  • Serum chemistry

  • Beta-2 microglobulin (B2M)

  • Serum protein electrophoresis

  • IgM quantification

  • CT scans with contrast when possible

MRI is usually not necessary for the purposes of clinical management; however, MRI of the spine shows findings of bone marrow involvement in 90% of patients.

In asymptomatic patients, a skeletal survey and radiographic imaging of the bones are generally not indicated, as lytic bone lesions are not common.

Hepatitis B and C screening is necessary only if rituximab therapy is being considered after confirmed diagnosis.

Learn more about the workup of WM.


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