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Through the looking crystal: clarifying the pathogenesis and laboratory work-up of cryocrystalglobulinaemia
  1. Rivak Punchoo1,2
  1. 1 Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  2. 2 Chemical Pathology, Tshwane Academic Divsion, National Health Laboratory Service, Pretoria, South Africa
  1. Correspondence to Dr Rivak Punchoo, Chemical Pathology, University of Pretoria Faculty of Health Sciences, Pretoria 0001, South Africa; rivak.punchoo{at}

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Cryoglobulins are immunoglobulins that precipitate or gel out of serum at temperatures less than 37°C and resolubilise on warming.1 Cryoglobulinaemia can cause vascular sludging or immune-mediated inflammation that classically presents with Meltzer’s triad of pupura, arthralgia and weakness.2 Cryocrystal formation is rare and can induce occlusive vasculopathy, thrombosis and inflammation.3 The aetiology of cryoglobulinaemia commonly includes infections, autoimmune diseases and haematological malignancies.2 Cryoglobulins are classified into three types based on clonality and immunoglobulin typing.4 Type 1 consists of monoclonal immunoglobulin only; in contrast to mixed cryoglobulinaemia (types 2 and 3). Type 2 comprises monoclonal IgM and polyclonal IgG, and type 3 is constituted by polyclonal IgM …

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  • Handling editor Tahir S Pillay.

  • Contributors Conceptualised, wrote and revised all drafts of the manuscript.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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