Cryoglobulinemia: MedlinePlus Medical Encyclopedia

P Cryoglobulinemia is the presence of abnormal proteins in the blood. These proteins thicken in cold temperatures.

T Causes
P Cryoglobulins are antibodies. It is not yet known why they become solid or gel-like at low temperatures. When this occurs, these antibodies can cause inflammation and block blood vessels. This may lead to problems ranging from skin rashes to kidney failure.
P Cryoglobulinemia is part of a group of diseases that cause damage and inflammation of the blood vessels throughout the body (vasculitis). There are three main types of this condition. They are grouped based on the type of antibody that is produced:
- Type I
- Type II
- Type III
P Types II and III are also referred to as mixed cryoglobulinemia.
P Type I cryoglobulinemia is most often related to cancer of the blood or immune systems.
P Types II and III are most often found in people who have a long-lasting (chronic) inflammatory condition, such as an autoimmune disease or hepatitis C. Most people with the type II form of the disease have a chronic hepatitis C infection.
P Other conditions that may be related to cryoglobulinemia include:
- Leukemia
- Multiple myeloma
- Primary macroglobulinemia
- Rheumatoid arthritis
- Systemic lupus erythematosus

T Symptoms
P Symptoms will vary depending on the type of disorder you have and the organs that are involved. Symptoms may include:
- Breathing problems
- Fatigue
- Glomerulonephritis
- Joint pain
- Muscle pain
- Purpura
- Raynaud phenomenon
- Skin death
- Skin ulcers

T Exams and Tests
P The health care provider will do a physical exam. You will be checked for signs of liver and spleen swelling.
P Tests for cryoglobulinemia include:
- Complete blood count (CBC).
- Complement assay -- numbers will be low.
- Cryoglobulin test -- may show presence of cryoglobulins. (It is a good idea to check to make sure the lab has experience drawing and storing blood for this test.)
- Liver function tests -- may be high if hepatitis C is present.
- Rheumatoid factor -- positive in types II and III.
- Skin biopsy -- may show inflammation in blood vessels, vasculitis.
- Protein electrophoresis - blood -- may show an abnormal antibody protein.
- Urinalysis -- may show blood in the urine if the kidneys are affected.
P Other tests may include:
- Angiogram
- Chest x-ray
- ESR
- Hepatitis C test
- Nerve conduction tests, if the person has weakness in the arms or legs

T Treatment
P MIXED CRYOGLOBULINEMIA (TYPES II AND III)
P Mild or moderate forms of cryoglobulinemia can often be treated by taking steps to deal with the underlying cause.
P Current direct-acting hepatitis C treatments work for most people who have hepatitis C and mild or moderate disease. As hepatitis C goes away, the cryoglobulins should disappear.
P Severe cryoglobulinemia involves vital organs or large areas of skin. It is treated with corticosteroids and other medicines that suppress the immune system.
- Rituximab is an effective drug and has fewer risks than other medicines.
- Cyclophosphamide is used in life-threatening conditions where rituximab is not working or available. This medicine was used often in the past.
- A treatment called plasmaphereis is also used. In this his procedure, blood plasma is taken out of blood circulation and abnormal cryoglobulin antibody proteins are removed. The plasma is replaced by fluid, protein, or donated plasma.
P TYPE I CRYOGLOBULINEMIA
P This disorder is due to a cancer of the blood or immune system such as multiple myeloma. Treatment is directed against the abnormal cancer cells that produce the cryoglobulin.

T Outlook (Prognosis)
P Most of the time, mixed cryoglobulinemia does not lead to death. Outlook can be poor if the kidneys are affected.

T Possible Complications
P Complications include:
- Bleeding in the digestive tract (rare)
- Heart disease (rare)
- Infections of ulcers
- Kidney failure
- Liver failure
- Skin death
- Death

T When to Contact a Medical Professional
P Call your provider if:
- You develop symptoms of cryoglobulinemia.
- You have hepatitis C and develop symptoms of cryoglobulinemia.
- You have cryoglobulinemia and develop new or worsening symptoms.

T Prevention
P There is no known prevention for the condition.
- Staying away from cold temperatures may prevent some symptoms.
- Testing and treatment for hepatitis C infection may reduce your risk.

T Images
- Cryoglobulinemia of the fingers
- Cryoglobulinemia - fingers
- Blood cells

T References
P De Vita S, Quartuccio L, Isola M, et al. A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64(3):843-853. PMID: 22147661 www.ncbi.nlm.nih.gov/pubmed/22147661.
P Rajkumar SV. Plasma cell disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 187.
P Rossa AD, Tavoni A, Bombardieri S. Cryoglobulinemia. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 163.
P Stone JH. Immune complex-mediated small vessel vasculitis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 91.

T Review Date 2/8/2017
P Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

