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At a glance

Cryoglobulinemia leading to hematuria, anasarca, and progressive deterioration of the renal function. As the patient ages, hypertension, proteinuria, and elevated serum creatinine are present. Special attention to hypothermia and the possibility of hepatitis C must be provided.

Synonym

Mixed Familial Cryoglobulinemia.

History

This medical condition was first described in 1966 by M. Meltzer. Their association of cryoglobulinemia and systemic manifestations is named of Meltzer Syndrome.

Incidence

The exact incidence remains unknown.

Genetic inheritance

Autosomal dominant.

Clinical aspects

Cryoglobulinemia with systemic manifestations has acquired the name Meltzer Syndrome. Cryoglobulins are immunoglobulins that persist in the serum, precipitate at cold temperature, and resolubilize when rewarmed. Type I is often associated with hematologic disorders. Types II and III are mixed, composed of different immunoglobulins with a monoclonal component in Type II and only polyclonal immunoglobulins in Type III. Hepatitis C virus is involved in most previously called essential mixed cryoglobulinemia. Dermatologic, rheumatologic, and nephrologic manifestations are the most frequent; neurologic complications are found in 20% of cases. End-stage cases may lead to renal insufficiency, hypertension, and anasarca.

Anesthetic considerations

Assessment of renal function is mandatory; check for hepatitis C. Keep all the perfused fluids (blood and electrolytes solutions) warm and pay attention to normothermia. In procedures that require hypothermia, plasma exchanges may help.

Pharmacological implications

There is no specific implication.

References

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Maisonobe  T, Leger  JM, Musset  L,  et al: Neurological manifestations in cryoglobulinemia. Rev Neurol (Paris) 158:920, 2002.  [PubMed: 12407300]
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Meltzer  M, Franklin  EC, Elias  K, McCluskey  RT, Cooper  N: Cryoglobulinemia—a clinical and laboratory study. Am J Med 40:837–856, 1966.  [PubMed: 4956871]
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Sitomer  G, Blum  JJ, Slavin  RE: Cryoglobulinemia: An inherited molecular disease? Am J Med 34:565–571, 1963.  [PubMed: 13977780]

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