Cryoglobulinemic Vasculitis
The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness
follow this 🧵to learn the history of these strange proteins
#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology
The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness
follow this 🧵to learn the history of these strange proteins
#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology
it starts in 1933
Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma
Her WBCs were very low
YET....the buffy coat (where WBCs like to live) was very large.
if her WBCs were low, what was accounting for the large buffy coat?
Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma
Her WBCs were very low
YET....the buffy coat (where WBCs like to live) was very large.
if her WBCs were low, what was accounting for the large buffy coat?
he can't figure it out, so what does he do?
he puts the blood in the freezer so he can ponder why the buffy coat is so thick.
the next day...
A strange precipitate in the tube
...that dissolved away when warmed back up
he puts the blood in the freezer so he can ponder why the buffy coat is so thick.
the next day...
A strange precipitate in the tube
...that dissolved away when warmed back up
Wintrobe didn't know these strange proteins were antibodies
he just knew the proteins had an unusual characteristic of precipitating out in colder ❄️ temperatures, so he called them cryoprecipitate.
he just knew the proteins had an unusual characteristic of precipitating out in colder ❄️ temperatures, so he called them cryoprecipitate.
in the 1960s Dr. Meltzer and Dr. Franklin study these strange proteins
recognizing them as antibodies
changing the term to cryo-globulins (instead of immunoglobulins)
recognizing them as antibodies
changing the term to cryo-globulins (instead of immunoglobulins)
they found it's not just the cold that makes the cryos precipitate
changes in:
1⃣ temperature
2⃣ concentration
3⃣ salinity
4⃣ pH
can lead to precipitation
changes in:
1⃣ temperature
2⃣ concentration
3⃣ salinity
4⃣ pH
can lead to precipitation
So now we know it's not just the cold that causes precipitation of these antibodies there are many factors
this likely helps explain why cryos can cause inflammation in a variety of tissues
this likely helps explain why cryos can cause inflammation in a variety of tissues
Also, not all cryos are created equal
we learn different conditions cause different cryoglobulins with different pathophysiology
Dr. Wintrobe's patient with multiple myeloma has a very different cryoglobulin than a patient who has Sjogren syndrome or Hep C.
we learn different conditions cause different cryoglobulins with different pathophysiology
Dr. Wintrobe's patient with multiple myeloma has a very different cryoglobulin than a patient who has Sjogren syndrome or Hep C.
stay tuned for another thread, walking through the basics of the different types of cryos and unraveling the pathophysiology of these interesting antibodies
...or skip ahead and listen to this podcast:
podcasts.apple.com/us/podcast/hea…
...or skip ahead and listen to this podcast:
podcasts.apple.com/us/podcast/hea…
Wintrobe MM, Buell MV. Hyperproteinemia associated with multiple myeloma. Bull Johns Hopkins Hosp 1933;52:156–65
Meltzer, M. Franklin, E.C. Cryoglobulinemia-A Study of twenty-Nine Patients American Journal of Medicine 1965
Meltzer, M. Franklin, E.C. Cryoglobulinemia-A Study of twenty-Nine Patients American Journal of Medicine 1965
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