Causes and risk factors
The exact cause of cryoglobulinemia is not known. The clumps deposited can block the blood vessels leading to various problems such as from skin rash to kidney failure. Thickness of blood will cause clots leading to vasculitis. Conditions associated with cryoglobulinemia include rheumatoid arthritis, Mycoplasma pneumoniae, leukemia, multiple myeloma, primary macroglobulinemia, and systemic lupus erythematosus. There are 3 kinds of cryoglobulinemia depending upon the antibodies they produce. They are cryoglobulinemia I, cryoglobulinemia II, cryoglobulinemia III. I is related to blood cancer. II and III is associated with people having chronic diseases such as autoimmune disease or hepatitis C.
Clinical presentation
The signs and symptoms depend on the organ that is involved; like skin, joints, muscles, kidney, and liver. The symptoms also include breathing problems, fatigue, joint and muscle pain. Symptoms may include acrocyanosis, i.e., persistent bluish discoloration of skin on hands and feet, etc., as a result of vasoconstriction. There is retinal hemorrhage. Arterial thrombosis can occur. Glomerulonephritis can occur. Purpura, Raynaud’s phenomenon, skin ulcers, and skin death may be seen.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Signs of spleen and liver swelling are examined. Complete blood count is advised. Cryoglobulin test (which may show presence of cryoglobulins) is done. Urinalysis helps if the kidney is affected, as this test may show blood in the urine. Liver function tests are recommended. Test for rheumatoid factor is done. Complement assay is advised. Other tests include hepatitis C test, protein electrophoresis – blood. Chest x-ray, angiogram is required. Skin biopsy is done. Nerve conduction tests may be done if the patient is having weakness in the arms or legs.
Treatment
The treatment includes treating the underlying causes; mild cases can be treated with avoidance of cold temperature or stress. If the patient has hepatitis C infection with cryoglobulinemia, then standard hepatitis C treatment is followed. For severe cases, corticosteroids and other medications to calm the immune system are required. In some cases, plasmapheresis is done.
Other Modes of treatment
The other modes of treatment can also be effective in treating cryoglobulinemia. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating cryoglobulinemia.
