Cryoglobulinemia Follow-up

Updated: Jan 09, 2019
  • Author: Colin C Edgerton, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print
Follow-up

Further Outpatient Care

Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis.

Next:

Further Inpatient Care

See the list below:

  • Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy.

  • Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting.

Previous
Next:

Inpatient & Outpatient Medications

See the list below:

  • Consider the use of NSAIDs in patients with mild symptoms of arthralgias, fatigue, or malaise without evidence of vasculitis.

  • Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist.

Previous
Next:

Transfer

Consider transferring patients who meet criteria for admission to a facility able to accommodate patients who require possible subspecialty consultation with a rheumatologist, hematologist, gastroenterologist/hepatologist, or nephrologist. In patients with evidence of potential end-organ compromise, consider transfer to a facility able to accommodate intensive or critical care patients.

Previous
Next:

Complications

Complications include the following:

  • Stroke, seizure, or coma

  • Blindness

  • Acute myocardial infarction

  • Pericarditis

  • Congestive heart failure

  • Respiratory distress

  • Gastrointestinal hemorrhage

  • Acute renal failure

  • Severe cutaneous necrosis or gangrene

Previous
Next:

Prognosis

As discussed in Mortality/Morbidity, the prognosis in these patients depends on the presence of underlying diseases (eg, lymphoproliferative disorders, hepatitis B or C infection, connective-tissue disease), all of which increase the mortality rate over that of the healthy population and more accurately direct estimates of individual survival. Renal disease portends a poorer prognosis.

Previous
Next:

Patient Education

Inform patients of the symptom complexes that may indicate acute cryoglobulinemia so medical therapy can be sought early to avoid potential organ damage. Patients with less severe disease that manifests primarily as arthralgias and fatigue benefit from understanding the precipitating factor (ie, cold temperatures, trauma). Avoidance and use of NSAIDs may reduce symptoms.

Previous