Table 4.
Clinico-diagnostic assessment of mixed cryoglobulinemia (MC) syndrome
| 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 |
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