Blood Tests & WM

Blood tests play a big role in the diagnosis & treatment planning of your Waldenstrom’s macroglobulinemia. Learn what to expect on this page.

What is a blood test?

A blood test is when a sample of your blood is taken to be examined in a laboratory. Blood is drawn through a small needle from one of your veins by a trained healthcare professional.

Blood work, is one of the most common types of lab test. Blood is collected in a small tube. Depending on how many tests you’re having, you might need to fill more than one tube. A blood test can be done as an outpatient and is usually over within a few minutes. Although you might feel a pinch or small scratch when the needle is inserted, you shouldn’t feel any further pain. Some people might have a small bruise afterward. The blood tests will be sent to different laboratories depending on what tests have been requested. Usually, they will be sent to a haematology laboratory for the blood cells to be “counted” by a machine or pathologist (a doctor who studies blood samples and body tissues). They will also be sent to a biochemistry laboratory where a machine will measure the salt and protein levels in your blood. This helps doctors understand how well your kidneys and liver are working and how many abnormal cells your body is producing. When your healthcare team receives the results, they will discuss them with you, and you may receive a copy. Results can take between a few days or a couple of weeks to be returned. Some people get anxious about having blood taken. If you’re worried about the test or have had reaction before (like feeling dizzy or fainting), talk to your healthcare team beforehand.

Why do I need blood tests?

Blood tests can help your healthcare team understand whether your Waldenstrom’s macroglobulinaemia is stable (not changing), getting worse or getting better.

Although blood tests are important in helping your doctor to understand what is happening in your body, they don’t paint a full picture. ‘Normal’ blood counts vary from person to person. A blood count that could indicate one person with Waldenstrom’s macroglobulinaemia needs treatment, might not mean the same for someone else. For this reason, it’s important not to put too much emphasis on them.

Instead, be sure to report any symptoms you have with your doctor and be honest with how you feel. Symptoms play an equally important role in helping your doctor to decide if you need further tests or treatment.

What kinds of blood tests will I have?

There are many kinds of blood tests. Below are some examples of the ones commonly used to diagnose and monitor Waldenstrom’s macroglobulinaemia. You may never have some of these tests. Some are used to monitor a certain condition, or when your doctor suspects or wants to check if you have developed a condition.

Your doctor may also order other blood tests to check the function of your organs, find evidence of other diseases like HIV, and look at the levels of sugars, fats and salts. You can find a full list of blood tests and what they mean here

Full blood count (FBC)
An FBC is actually a series of tests, all looking at different parts of your blood. You can read more about these different elements here.

Your blood is made up of three types of cells: red blood cells, white blood cells, and platelets. A full blood count (FBC) measures or ‘counts’ these cells.

People with Waldenstrom’s macroglobulinaemia may have low counts of blood cells, which can cause various symptoms and conditions, like anaemia. This is because the abnormal B-cells that cause WM take up the space in the bone marrow where healthy cells would normally be.

You will regularly have an FBC to help your healthcare team monitor your WM. If your blood counts drop and become lower, it could mean that your WM is progressing and that you may require treatment soon. However, there are other causes of low blood counts, and your medical team may request tests to look for other causes of these changes.

An FBC can also be called a complete blood count (CBC).

Serum quantitative immunoglobulins
B-cells are a type of white blood cell. Some B cells produce immunoglobulins – also known as antibodies – that help fight infection. In people with Waldenstom’s macroglobulinaemia, B-cells develop incorrectly and produce abnormal amounts of a type of immunoglobulin called IgM.

This test is used to count the number of immunoglobulins in your blood. It shows doctors if you have higher levels of IgM, which can indicate that you have Waldenstom’s macroglobulinaemia. It can also be used to monitor your WM once you have been diagnosed, and see whether you are producing enough of your other immunoglobulins such as IgG, which is important to protect you from infections.

Serum protein electrophoresis and immunofixation
These tests look more closely at the immunoglobulins in your blood and show doctors if you are producing the abnormal IgM seen in people with Waldenstom’s macroglobulinaemia. Abnormal immunoglobulins are sometimes called monoclonal antibodies or paraproteins.

If your tests show that you have abnormal IgM (also written as monoclonal gamma globulin), it can indicate that you have Waldenstom’s macroglobulinaemia, and your doctor will refer you for more tests.

Monitoring the levels of abnormal IgM is also useful to understand how your WM is progressing. However, levels differ from person to person – what might cause one person to have symptoms, may leave another symptom-free.

Your doctor may refer to an ‘M spike’ when talking about the amount of IgM in your blood. This number shows if there is a large amount of one immunoglobulin (IgM when talking about WM) and shows up as a sharp ‘spike’ on a graph.

Results from your serum protein electrophoresis and immunofixation tests are given in grams per litre, written as g/L.

Plasma viscosity
This test measures the thickness – or viscosity – of your blood. In people with Waldenstom’s macroglobulinaemia, the abnormal levels of IgM make the blood thicker, causing a condition caused hyperviscosity syndrome (HVS) that needs medical care.

Results from your plasma viscosity test are given in milliPascal second, written as mPas. You doctor should consider that you may have HVS if your level is greater than 3mPas, but as always levels differ from person to person and symptoms also play their part in diagnosis.

Cryocrit (cryoglobulin or cryoprotein)
This test is usually only used if you have symptoms of the condition cryoglobulinaemia. This occurs in some people with Waldenstom’s macroglobulinaemia, who produce a protein called cryoglobulin. Cryglobulins are sensitive to cold temperatures and clump together when your body temperature drops, blocking blood flow.

The test is more complex than normal blood tests, which is why it isn’t routinely used. The blood has to be collected in a prewarmed tube, and the sample has to be kept at body temperature before being refrigerated for at least 72 hours.

The test results are either positive or negative. If they are positive and you have symptoms, it can indicate that you have cryoglobulinaemia.

Serum free light chains (SFLC)
People with Waldenstom’s macroglobulinaemia produce abnormal IgM. Usually, immunoglobulins like IgM are made up of chains of proteins – two ‘heavy’ chains and two ‘light’ chains. Around 80% of people with Waldenstom’s macroglobulinaemia produce large amounts of light chains that don’t connect to form whole immunoglobulins. These are called ‘free light chains’.

Free light chains are split into two groups – kappa and lambda – and the test will show how many of each you have.

Your results will be shown in milligrams per litre, written as mg/l. You’ll get a count for both kappa and lambda, and then a ratio of the two so your doctor can see if you are producing one type more than the other. If your ratio between the kappa and lambda significantly increases, it can mean that your WM is progressing. Likewise, if the ratio returns to a more normal number, it might mean that treatment is working.

Your doctor may order the test if you have been diagnosed with or have symptoms of conditions caused by the free light chains, for example amyloidosis.

It can be a useful test if you have been diagnosed with lymphoplasmacytic lymphoma (LPL). People with LPL don’t have the higher levels of IgM to monitor, so monitoring the kappa and lambda chains can help doctors to understand how their disease is progressing.

Beta-2 (β2) microglobulin
The beta-2 microglobulin (β2M) is a protein that people with Waldenstom’s macroglobulinaemia produce a lot of. This test counts how much of the protein is in your blood.

Having high quantities of β2M doesn’t help your doctor diagnose you, however it can show how active your WM is and indicate your prognosis. Higher levels of β2M can mean a poorer prognosis.

Understanding your blood test results

Blood test results aren’t always straight forward to understand.

Lab Tests Online breaks down how to read your results but your doctor should explain what each result means and if any action needs to be taken, for example further tests or starting treatment.

Most tests will show your result, alongside what is considered to be a ‘normal range’. However, the normal range can vary from laboratory to laboratory.

It’s important to remember that blood test results are only one part of the picture. Your doctor will also take into account how you are feeling, and any symptoms you have when discussing treatment or diagnosis with you.

You might find it helpful to talk about results with others in a similar position, to help you understand things better. However, try not to compare results – a result that leads one person to start treatment, may not mean the same for another.

Results are reported differently in different countries, so don’t be alarmed if you see someone from another country share results and they show very different numbers to yours.

If you are worried about your results, talk to your healthcare team who will be able to offer you advice for your unique circumstances.