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
Beta-2 microglobulin (B2M)
Serum protein electrophoresis
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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Cite this: Emmanuel C. Besa. Fast Five Quiz: Waldenström Macroglobulinemia Workup - Medscape - Feb 01, 2021.