Table 4 Clinico-diagnostic assessment of mixed cryoglobulinemia (MC) syndrome
From: Mixed cryoglobulinemia
Clinical and serological work-up at patient's first evaluation |
|---|
   • past clinical history, physical examination |
   • chest x-ray, EKG, abdominal US, blood chemistry & urinalysis |
   • cryoglobulin detection and characterization (see Tab. 1) |
   • RF, C3–C4, ANA, anti-ENA, ANCA, ASMA, AMA, anti-LKM1, others auto-Ab |
   • virological markers: HCV (genotyping), HBV, others |
   • evaluate possible comorbidities (cardiovascular, endocrine/metabolic, etc.) |
   • MC classification (definite, essential, secondary): see Tab. 3 |
Diagnosis & monitoring of major MC complications |
   • chronic hepatitis, cirrhosis, hepatocellular carcinoma: monitoring (every 6–12 month) of ALT, AP & liver US (biopsy, CT scan) |
   • glomerulonephritis: monitoring of urinalysis & serum creatinine (kidney US, biopsy) |
   • peripheral neuropathy: clinical monitoring; EMG |
   • skin ulcers: exclusion of vascular comorbidities (A-V Doppler evaluation) |
   • sicca syndrome: differential diagnosis with primary SS (see Fig. 7) |
   • arthritis: differential diagnosis with RA (see Fig. 7) |
   • thyroid involvement: hormones, auto-Ab, neck US, fine-needle aspiration |
   • B-cell lymphoma: clinical monitoring; bone marrow/lymph node biopsies, total body CT scan |