Waldenstrom Macroglobulinemia Complications

Common Complication

Hyperviscosity syndrome is perhaps the most common complication of Waldenstrom’s macroglobulinemia.

Most complications associated with Waldenstrom’s macroglobulinemia can be traced to a high concentration of IgM antibodies circulating through the blood vessels. Not all people with WM will experience these complications as the disease often progresses without noticeable symptoms. Being aware of possible complications is important, however. Inform your doctor if you experience any of the symptoms associated with these conditions.

Hyperviscosity Syndrome

Hyperviscosity syndrome is perhaps the most common complication of Waldenstrom’s macroglobulinemia. Abnormally high levels of IgM antibodies cause the blood to “thicken.” As a result, circulation through the body’s small blood vessels slows, causing a number of possible symptoms, including:

  • bleeding from the mucous membranes in the nose and mouth
  • fatigue
  • headaches
  • muscle weakness
  • vision problems
  • nerve damage and degeneration.

Excess amounts of IgM antibodies may be directly responsible for nerve degeneration linked to hyperviscosity. Evidence suggests that the antibodies react with myelin proteins in a manner that resembles multiple sclerosis.

The IgM Pentamer

Unlike other antibodies, which occur singly (monomers), the IgM antibodies seen in Waldenstrom’s macroglobulinemia form a chain of five IgM molecules bound together (pentamer). The size of the IgM pentamer is responsible for hyperviscosity in up to 75 percent of WM patients.

Raynaud’s Phenomenon

The large IgM antibodies that develop due to WM solidify when exposed to cold temperatures, causing a vascular disorder called Raynaud ‘s phenomenon. When the IgM antibodies solidify, they clump together to form cryoglobulins. These cryoglobulins block the small blood vessels in the fingers and toes. Pain and a cold sensation are experienced in the fingers or toes, and the affected digits may appear white or white with red patches. Warmer temperatures cause symptoms to fade.

Retinal Vascular Dilation

Retinal vascular dilation occurs when the blood, thickened by IgM antibodies, widens the blood vessels in the eye’s retina. Examination of the eye with a fundoscope reveals the enlarged blood vessels. (A fundoscope allows an optometrist to examine the back of the eye.) Without treatment, retinal vascular dilation can lead to vision impairment, and even blindness.

Infections and Other Complications

As Waldenstrom’s macroglobulinemia progresses, high levels of irregular B cells and IgM antibodies cause an imbalance in blood cell levels. This imbalance compromises the immune system. Infections are more likely to occur and reoccur as the immune system weakens.

Less common complications caused by IgM imbalances include gastrointestinal bleeding and heart failure. Neurological disorders may also occur and may, in rare cases, result in coma.