A few days ago Bob asked the following question in the health forums:

Hi Guys,
My mother, after having a mild stroke, was said to have "Hyperviscosity" of her blood.
The doctors are still not sure, but they say she has "Waeldenstrom’s Macroglobulinemia" or something like that.
Is it common? Never heard of it. BTW she’s 68 YO.
I would really like to know if there’s a cure for it.
Thanks DAD dudes!!
Bob

 

Read on, Bob, to find out about the disease.

Danger level: High

Health forums category: Cancer

What is it?

Waldesntrom’s macroglobulinemia (WM) is a type of cancer in the blood.

Who gets it?

The disease is quite rare – only about 1,500 cases are diagnosed in the US each year (in the UK, about 10 people out of a million get it each year).

It’s more common in white people (only about 5% of patients are of African origin).

WM is a little more common in men than in women, and it tends to happen around age 65.

What causes it?

Our blood contains many types of cells. One of these types is white blood cells. These cells belong to our immune system and are meant to fight infections.

Like there are many types of cells in the blood, there also several types of white blood cells (five types, actually). One of these types is lymphocytes. To make things even more complicated, lymphocytes themselves are divided into T cells and B cells (and that’s where the complication stops).

Lymphocytes. In WM, this cell goes bad.

WM is a disease of B cell lymphocytes. There are 2 problems these cells cause in this disease:

1. B cells produce molecules called antibodies. Think of them as the weapons used by these cells to kill the bad guys. There is a type of antibody called IGM, which looks something like this:
    
   In WM B cells create too much of this antibody. The blood is then filled with these IGMs floating about. Because of their large structure, they cause the blood to become less liquid and more sticky, or viscous. The condition is then called hyperviscosity syndrome. This can lead to things such as nosebleed, dizziness, gum bleeding and blurred vision.
2. In WM, like in other cancers, B cells multiply uncontrollably. They start infiltrating organs in the body.

How does it feel?

Some people don’t feel anything when they have WM. When people do have symptoms, they can include:

a. Weakness

b. Fatigue

c. Bleeding from the nose or gums

d. Weight loss

e. Bruises in the skin

When the condition is more severe (meaning the blood is thicker) other things which may occur include:

a. Blurring or loss of vision

b. Neurological problems – These include headaches, dizziness, and vertigo.

c. Sometimes a stroke or coma may also ensue.

How is it discovered?

A few tests are done to discover WM:

1. Blood tests: They discover, among other things, the high level of IGM in the blood.
2. A bone marrow biopsy: A sample of bone from the back of the pelvis is taken using a needle. It is then examined under a microscope.

How is it treated?

There’s no cure for WM. If someone doesn’t have any symptoms, usually no treatment is needed. If symptoms are present, though, usually chemotherapy is used.

In cases of hyperviscosity syndrome, where high levels of IGM are present in the blood, a treatment called plasmapharesis is used. In it blood from the patient is removed and circulated through a machine that separates the plasma (which contains the IGMs) from other parts of the blood (such as red and white blood cells). The blood cells are then returned to the patient, along with a plasma substitute.

What happens after treatment?

With treatment, people may live with the disease for longer than 10 years (this is considered good, since in the past people only survived for about 5 years after the diagnosis).

The bottom line – How do I avoid It?

Unfortunately, there is no known way to prevent WM.

Related posts:

1. Neuroblastoma – The Most Common Cancer in Infants
2. Multiple Myeloma – Bone Marrow Cells Taking Over
3. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

Danger level: Medium

What is it?

Iron deficiency anemia is a type of anemia caused by a lack of iron in the body.

Who gets it?

Iron deficiency anemia is common. In the United States it affects about 1-2% of people.

There are groups of people more likely to have iron deficiency anemia:

1. Women – Women of childbearing age lose blood monthly in their period. This puts them at risk for iron deficiency anemia. Pregnancy also causes a higher demand for iron, which may bring about iron deficiency anemia.
2. Infants and children – Newborn infants have stores of iron which should last for their first months of life, after which a supplementation is recommended if they are breast fed, or iron-fortified formulas are recommended if they are formula fed. Children need extra iron during growth spurts (it’s important for muscle development).
3. Vegetarians – Our main source of iron is meat. Since vegetarians don’t eat meat, they are at greater risk of iron deficiency anemia. (The iron in grains and vegetables isn’t absorbed as well as the iron in meat).
4. People with decreased absorption of iron in the intestines – Such as people with celiac disease.

Unless you’re a hamster, eating only vegetables can bring about iron deficiency anemia. Photo by shhexycorin.

If you have iron deficiency anemia and you are not included in one of those groups, the cause may be a hidden source of bleeding within your body, such as a peptic ulcer, hemorrhoids, cancer or other causes.

What causes it?

Iron is needed by the body to make hemoglobin. As you can read in our anemia article, hemoglobin carries oxygen in our red blood cells to reach all parts of the body. When there’s not enough iron, hemoglobin cannot be formed, which leads to iron deficiency anemia.

How does it feel?

As with all cases of anemia, iron deficiency anemia causes you to feel weak and tired easily. You may look pale. If it is severe, you may feel short of breath. Other things which can appear are headaches and irritability.

Other, less common things which can occur in iron deficiency anemia include:

1. Pica – This is a phenomenon in which people eat things that aren’t considered food, such as clay, coal, soil, ice.
2. Spoon-shaped nails
3. Angular Chelitis – These are wounds in the corners of the mouth.
4. Glossitis – This is an inflammation of the tongue, which causes it to swell and change color.

And others…

How is it discovered?

There are blood tests which can discover if you have iron deficiency anemia:

1. Complete blood count (CBC) – It checks, among other things, the level of hemoglobin. It also allows the doctor to see the blood under a microscope, which gives clues to the cause of the anemia.
2. Blood tests to check your levels of iron

If the doctor suspects you have a bleeding somewhere in your body which causes the anemia, they may check your stool for blood or examine your digestive tracts to look for a cause.

How is it treated?

The treatment is simple: iron. It may be taken as a pill or given as an injection (in people who can’t absorb the iron properly due to a problem in their intestines, or those who have side effects when taking the pill).

What happens after treatment?

Most people begin to feel better after a few days of treatment. The treatment is needed for several months, though, to build up the iron in the body.

The bottom line – How do I avoid it?

You can avoid it by eating foods rich in iron, such as red meat, pork, seafood, poultry, eggs, iron fortified cereals/bread/pasta, beans, peas, dark green leafy vegetables (such as spinach), nuts and seeds, and dried fruit (like raisins and apricots). Iron coming from meat is absorbed better than the other types.

It’s also known that drinking citrus juice while eating iron containing foods helps with its absorption.

Related posts:

1. Anemia – All About It
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Ornithine Transcarbamylase Deficiency– What If You Couldn’t Eat Steaks? (As Seen on House MD)

Danger level: Medium

What is it?

G6PD deficiency is a hereditary disease causing anemia in certain situations.

Who gets it?

G6pd deficiency is an inherited disease. Its mode of inheritance is X-linked. This means that the mutation is caused in the X chromosome (one of our 46 chromosomes). For reasons beyond the scope of this article, this means that it almost always occurs only in males.

It’s most common in people of Mediterranean (Italian, Greek, Arab, Sephardic Jewish) or African origin (in the US, it occurs in about 10% of African Americans). It affects about 200 million people worldwide.

What causes it?

G6PD is an enzyme in our body which helps the body produce gluthatione. Gluthatione is a molecule which helps to protect the body against free radicals, which are harmful molecules. These molecules can damage our red blood cells under certain conditions.

In G6PD deficiency, like the name says, there’s a deficiency in the G6PD enzyme. This means that people with the disease don’t produce enough gluthatione to fight the free radicals, which puts their red blood cells at risk.

The bright side – the red blood cells aren’t at risk all the time, but only in certain situations which raise the level of free radicals:

1. Taking certain drugs – Such as dapsone, primaquine, sulfamethoxazole, doxorubicin, methylene blue.
2. Infections
3. Certain foods – Such as fava beans. The interesting thing is that people with G6PD deficiency don’t even have to eat the beans in order to cause damage to the blood cells – it’s enough that they inhale their pollen.
4. Diabetic ketoacidosis – This is a condition that can happen to people with diabetes.

How does it feel?

Most of the time, people with G6PD deficiency are well. When the conditions mentioned above occur, there is a destruction of red blood cells, which leads to anemia and sometimes jaundice (yellowing of the skin). The destruction of red blood cells is called hemolysis. It can happen within hours of exposure to the condition (drug, food, etc.).

The level of the deficiency in G6PD (meaning how much of it exists in the body) will determine how bad the condition will get. Sometimes the hemolysis can stop once you stop taking the drug (this is more common in people of African origin), but it can also continue after you’ve stopped taking it. In severe cases, damage to the kidneys can occur.

The most important thing here is what can happen to babies with G6PD deficiency. A lot of babies have jaundice on their first days. In G6PD deficiency, this jaundice can be prolonged, which can cause damage to the brain.

How is it discovered?

There are a few things that can be done to discover the disease:

1. A blood smear – In which some drops of blood are smeared against a piece of glass and then looked at under a microscope. Certain things can be seen in G6PD deficiency because of the destruction of blood cells.
2. Checking the level of G6PD – To see that it’s indeed low.

How is it treated?

Since the destruction of blood cells usually stops by itself, no treatment is usually necessary. In severe cases, blood transfusions might be necessary.

In babies with jaundice, usually a treatment with a special kind of light helps to resolve the problem.

The bottom line – How do I avoid it?

You can’t prevent having the defect in the gene which causes the deficiency in G6PD. What you can do is avoid the things mentioned above which can trigger the destruction of blood cells (not eat any fava beans (or smell their pollens), avoid the dangerous drugs, avoid infections).

Related posts:

1. Iron Deficiency Anemia – A Common Type of Anemia
2. Multiple Myeloma – Bone Marrow Cells Taking Over
3. Ornithine Transcarbamylase Deficiency– What If You Couldn’t Eat Steaks? (As Seen on House MD)

Danger level: High

What is it?

Multiple myeloma is a blood cancer involving cells called plasma cells, in the bone marrow.

Who gets it?

In the US, 4 out of 100,000 people are found to have it each year. It’s a little more common in men than women, and almost twice as common in African American than in white people.

It’s usually found around the ages 65-70.

What causes it?

The bone marrow is the place within our bones where blood is produced. All types of blood cells (red blood cells, white blood cells and platelets) are produced there. 

One of the types of white blood cells (cells that are usually responsible for fighting infections) is plasma cells. They are responsible for producing antibodies – molecules that fight infections. In multiple myeloma, plasma cells divide in an uncontrolled manner and take over the bone marrow. They mass together and create tumors in different areas of the body, especially the bone marrow.

The bone marrow in multiple myeloma – Every purple round cell here is a plasma cell. They’ve taken over the bone marrow in this picture.

How does it feel?

Multiple myeloma can cause any of the following things:

1. Bone problems – The tumors of plasma cells in the bone can cause pain, usually in the back or chest, but it can also happen in the arms or legs. The other thing that happens to bone here is bone loss, which can lead to fractures. If these fractures happen in the spine, it can also cause neurologic problems.
2. High blood calcium levels – Bone here is lost. But the lost bone doesn’t just disappear. Bone contains calcium (among other things). When the bone is lost here, the calcium in it is released to the blood, which in high levels can cause loss of appetite, nausea, vomiting, constipation, thirst, weakness, confusion and even coma.
3. Anemia – Since more white cells are produced here, less red cells are produced – causing anemia and weakness (the red cells are responsible for delivering oxygen to our body).
4. Kidney problems – There are many reasons for this, such as the high levels of antibodies the many plasma cells here produce, and also the high calcium level in the blood. This causes the kidneys to fail.
5. Thickened blood – The many antibodies created here cause the blood to be thick, which causes flow problems, leading to bleeding from the mouth or nose, blurred vision, heart failure and neurologic problems.
6. More infections – We said that more plasma cells (which fight infections) are created here. But they are defective, and are created on the account of normal cells – this causes problems with fighting infections.

To better understand all of these complex symptoms you can watch this movie, which tells the story of 3 patients who found out they have multiple myeloma:

How is it discovered?

There are a few tests that can be done:

1. Blood tests and urine tests – They can find the high level of antibodies created by the plasma cells.
2. Bone marrow examination – This is done by a biopsy (cutting a piece of bone) or aspiration (“sucking” bone marrow with a needle). A picture similar to the one above will show. It takes an excess of more than 10% of plasma cells to prove that there is multiple myeloma.
3. X-rays: The bone destruction here causes “holes” in the bone, which are called “lytic lesions”. They will show on x-ray.

How is it treated?

There are several things that can be done to treat it:

1. Chemotherapy – It doesn’t cure the disease,but controls it.
2. Bone marrow transplantation – From the patient’s own body (the usual treatment) or from a donor.
3. Other types of drugs

What happens after treatment?

The disease tends to recur, and should be treated again. The survival in the disease can change according to many criteria, but it can go between years to months.

Unfortunately, there is no known way to prevent it. If you do feel any of the symptoms described above and you’re the right age, seeking medical help early might be the best course of action.

Have you encountered the disease yourself, or in someone you know? Share in the comments.

Related posts:

1. Paget Disease of Bone – Bone Deformity For An Unknown Reason
2. Waldenström’s macroglobulinemia – A Rare Blood Cancer That Can Lead To Strokes
3. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells