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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
  1. Abbreviations: F: rheumatoid factor; ANA: antinuclear antibodies; anti-ENA: anti-extractable nuclear antigen antibodies; AMA: antimitochondrial antibodies; ASMA: anti-smooth muscle antibodies; anti-LKM1: anti-liver/kidney microsome type 1 antibodies; ALT: alanine aminotransferase; AP: alkaline phosphatase; US: ultrasonography; CT: computed tomography; EMG: electromyography; RA: rheumatoid arthritis; SS: Sjögren's syndrome