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Test ID: CRGSP Cryoglobulin and Cryofibrinogen Panel, Serum and Plasma

Reporting Name

Cryo Panel, S and P

Useful For

Evaluating patients with vasculitis, glomerulonephritis, and lymphoproliferative diseases

 

Evaluating patients with macroglobulinemia or myeloma in whom symptoms occur with cold exposure

Clinical Information

Cryoglobulins are immunoglobulins that precipitate when cooled and dissolve when heated. Because these proteins precipitate when cooled, patients may experience symptoms when exposed to the cold. Cryoglobulins may be associated with a variety of diseases including plasma cell disorders, autoimmune diseases, and infections. Cryoglobulins may also cause erroneous results with some automated hematology instruments.

 

Cryoglobulins are classified as:

-Type I (monoclonal)

-Type II (mixed--2 or more immunoglobulins of which 1 is monoclonal)

-Type III (polyclonal--in which no monoclonal protein is found)

 

Type I cryoglobulinemia is associated with monoclonal gammopathy of undetermined significance, macroglobulinemia, or multiple myeloma.

 

Type II cryoglobulinemia is associated with autoimmune disorders such as vasculitis, glomerulonephritis, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome. It may be seen in infections such as hepatitis, infectious mononucleosis, cytomegalovirus, and toxoplasmosis. Type II cryoglobulinemia may also be essential, ie, occurring in the absence of underlying disease.

 

Type III cryoglobulinemia usually demonstrates trace levels of cryoprecipitate, may take up to 7 days to appear, and is associated with the same disease spectrum as Type II cryoglobulinemia.

 

A cryoprecipitate that is seen in plasma but not in serum is caused by cryofibrinogen. Cryofibrinogens are extremely rare and can be associated with vasculitis. Due to the rarity of clinically significant cryofibrinogenemia, testing for cryoglobulins is usually sufficient for investigation of cryoproteins.

Interpretation

An interpretive report will be provided.

Profile Information

Test ID Reporting Name Available Separately Always Performed
CRY_S Cryoglobulin, S Yes Yes
CRY_P Cryofibrinogen, P No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
IMFXC Immunofixation Cryoglobulin No No

Testing Algorithm

If cryoglobulin has a positive result after 1 or 7 days, then immunofixation will be performed at an additional charge. Positive cryoglobulins of 0.1 mL or above of precipitate will be typed once.

Analytic Time

2 days

Day(s) and Time(s) Performed

Monday through Friday; 4 p.m.

Clinical Reference

Kyle RA, Lust JA: Immunoglobulins and laboratory recognition of monoclonal proteins. Section III. Myeloma and related disorders. In Neoplastic Diseases of the Blood. Third edition. Edited by PH Wiernik, GP Canellos, JP Dutcher, RA Kyle. New York, Churchill Livingstone, 1996, pp 453-475

Method Name

CRY_S, CRY_P: Quantitation and Qualitative Typing Precipitation at 1 Degree C

Includes cryofibrinogen.

IMFXC: Immunofixation

Specimen Type

Plasma EDTA
Serum Red


Specimen Required


Both plasma and serum are required.

 

Cryofibrinogen

Collection Container/Tube: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Tube must remain at 37° C.

2. Centrifuge at 37° C. (Do not use a refrigerated centrifuge. If absolutely necessary, ambient temperature is acceptable.) It is very important that the specimen remain at 37° C until after separation of plasma from red cells.

3. Place plasma into an appropriately labeled plastic vial.

 

Cryoglobulin

Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 5 mL

Collection Instructions:

1. Tube must remain at 37° C.

2. Allow blood to clot at 37° C.

3. Centrifuge at 37° C. (Do not use a refrigerated centrifuge. If absolutely necessary, ambient temperature is acceptable.) It is very important that the specimen remain at 37° C until after separation of serum from red cells.

4. Place serum into an appropriately labeled plastic vial.

Additional Information: Analysis cannot be performed with <3 mL of serum. Smaller volumes are insufficient to detect clinically important trace (mixed) cryoglobulins. Less than 3 mL will require draw of a new specimen.


Specimen Minimum Volume

Serum: 3 mL
Plasma: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma EDTA Refrigerated (preferred)
  Frozen 
Serum Red Refrigerated (preferred)
  Frozen 

Reference Values

CRYOGLOBULIN

Negative (positives reported as percent)

If positive after 1 or 7 days, immunotyping of the cryoprecipitate is performed at an additional charge.

 

CRYOFIBRINOGEN

Negative

Quantitation and immunotyping will not be performed on positive cryofibrinogen.

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

82585

82595

86334-Immunofixation (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CRGSP Cryo Panel, S and P 74352-6

 

Result ID Test Result Name Result LOINC Value
2685 Cryofibrinogen, P 11043-7
2684 Cryoglobulin, S 12201-0

Forms

If not ordering electronically, complete, print, and send a Benign Hematology Test Request Form (T755) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Cerebrovascular, mml-Headache, mml-Demyelinating-Diseases, mml-Neuroimmunology, mml-Neuromuscular, mml-Autonomic, mml-Pediatric, mml-Spinal-Cord