Cryoglobulinemia

Cryoglobulinemia is characterized by clusters of cryoglobulins, abnormal antibody proteins in your blood, which form due to cold temperatures. Thickened plasma result due to these clumps which might also deposit in your blood vessels.

People above 50 are mostly affected by this condition. Symptoms are not evident in many cases. Symptoms, in moderate to severe cryoglobulinemia, include blocked arteries and damage to skin, joints, muscles, nerves, kidneys and liver.

Symptoms occur occasionally and may be precipitated by low temperatures. The exact cause of cryoglobulinemia is not clear. But several conditions, such as hepatitis C infection, multiple myeloma and autoimmune disease, are likely to contribute to the symptoms. 

Signs and symptoms of cryoglobulinemia are:

• Lethargy and tiredness
• Pain in joint (arthralgia)
• Burning or itchy skin of legs or feet that may turn into red or purple rashes (purpura)
• Fever
• Elevated blood pressure
• Swelling of ankles and legs
• Numb, tingling sensation or weakness in the hands or feet (peripheral neuropathy)
• Skin ulcer and gangrene (death of tissues in the affected part)
• Pain in abdominal

The exact cause of Cryoglobulinemia is unknown. Inflammation of blood vessels (vasculitis) and their blockage due to these clumps, can cause various symptoms including skin rashes and kidney failure.

Cryoglobulinemia is classified into three types based on type of associated antibody and they are:

Type I

This type is closely linked to cancer of the blood or immune systems.

Type II III

Also called mixed cryoglobulinemia, these types occur in people who suffer from chronic inflammatory diseases, such as autoimmune disease or hepatitis C.

Hepatitis C is a common diagnosis in people with Type II and III cryoglobulinemia.

Other possible causes of cryoglobulinemia are:

• Leukemia
• Multiple myeloma
• Mycoplasma pneumonia
• Primary macroglobulinemia
• Rheumatoid arthritis
• Systemic lupus erythematosus

Diagnosis of cryoglobulinemia begins with physical examination and medical history review. Other tests include:

• Complete blood count

• Urine test: To detect kidney function.

• Removing a sample of tissue from the affected area (skin biopsy) may provide more details on your condition.

• Liver function test: To detect Hepatitis C

• Cryoglobulin test: To detect presence of cryoglobulins

• Your doctor can also recommend tests to check other diseases such as lymphoma and autoimmune disease as co-occurrence of these diseases can help your doctor pinpoint your condition.

The treatment of cryoglobulinemia is focused to:

• Treating the cause of cryoglobulinemia, such as an infection
• Manage inflammation
• Prevent worsening of your condition
• Avoid possible damages to organ
• Avoid over-treating

The type, underlying cause and severity of cryoglobulinemia are the determinants for your treatment approach. An in-depth evaluation of your situation is necessary if you don't experience any symptoms.

For mild to moderate symptoms, you may consider

• bed rest,
• support hose,
• pain killer
• avoiding cold temperatures.

Your doctor may prescribe you medications, to be used alone or in combination, to relieve your symptoms and prevent precipitation.

These medications:

Control inflammation

Corticosteroids are effective in treating in cryoglobulinemia. But using these medications for prolonged time can cause severe side effects, such as infection.

Suppress your immune system

Monoclonal antibodies, such as rituximab, may be given either alone or in combination with steroids or chemotherapy.

Fight viral infections

If your cryoglobulinemia is caused due to hepatitis C, antivirals such as ribavirin can be prescribed.

Destroy cancer cells (Chemotherapy)

Low dose of chemotherapy can relieve mild to moderate symptoms while a combination of chemotherapy and plasmapheresis (exchanging your blood plasma with fluids) may be needed for severe symptoms.