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LETTER TO EDITOR
Year : 2013  |  Volume : 23  |  Issue : 6  |  Page : 465-466
 

Pseudohyperphosphatemia in Waldenstrom's Macroglobulinemia


1 Department of Clinical Hematology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
2 Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

Date of Web Publication24-Oct-2013

Correspondence Address:
S D Amalnath
Department of Clinical Hematology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.120351

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How to cite this article:
Amalnath S D, Dubashi B. Pseudohyperphosphatemia in Waldenstrom's Macroglobulinemia. Indian J Nephrol 2013;23:465-6

How to cite this URL:
Amalnath S D, Dubashi B. Pseudohyperphosphatemia in Waldenstrom's Macroglobulinemia. Indian J Nephrol [serial online] 2013 [cited 2022 Jan 21];23:465-6. Available from: https://www.indianjnephrol.org/text.asp?2013/23/6/465/120351


Sir,

A 50-year-old man presented with a progressive fatigue for 3 months. The only clinical finding was severe pallor. His hemoglobin was 3 g/dl, total leukocyte count 4500/cu.mm and platelet count 10,000/cu.mm with rouleaux formation in the peripheral smear. Marrow aspirate showed almost complete infiltration by lymphoplasmacytoid cells. Serum total protein was 8 g/dl with an albumin of 3.2 g.dl. Serum electrophoresis showed a M band. Serum IgG and IgA were normal with a very high-level of serum IgM (39.7 g/l, normal <5 g/l). There was neither renal dysfunction nor lytic lesions in the bones. Based on the above findings, a diagnosis of Waldenstrom Macroglobulinemia (WM) was made.

He was started on cyclophosphamide, vincristine, and prednisolone. On day 2, his calcium, phosphate, and uric acid levels were estimated for possible tumor lysis syndrome. Surprisingly, phosphate was very high (15.5 mg/dl) with other parameters being normal. These values persisted on repeat samples. There were no other clinical signs of tumor lysis.

Literature search revealed reports of pseudohyperphosphatemia in association with paraproteinemias. [1] The phosphate levels normalized at the end of two cycles of chemotherapy without any specific intervention.

High-levels of paraproteins have been known to interfere with estimation of various laboratory parameters causing falsely high levels of bilirubin, C reactive protein, ferritin, calcium, and falsely levels of sodium, thyroxin, glucose, uric acid, and albumin. [2] Both pseudo hyper and hypo phosphatemia [2],[3] have been noted in paraproteinemias.

Serum phosphate was estimated by Olympus AU 400 instrument by phosphomolybdate assay. The mechanisms of pseudohyperphosphatemia include analytical error of the proteins interfering with estimation or the presence of increased phosphate binding paraproteins. [1]

The true value can be estimated by precipitating the proteins and repeat estimation. We tried to deproteinate the sample but it was not successful.

Thus, we conclude by stating that falsely high serum phosphate is a rare but well-documented phenomenon in paraproteinemias and should not be mistaken for tumor lysis. Furthermore, incidentally detected pseudohyperphosphatemia with high serum total proteins may be a valuable clue to an underlying hypergammaglobulinemia.

 
  References Top

1.Loh TP, Saw S, Sethi SK. Hyperphosphatemia in a 56-year-old man with hypochondrial pain. Clin Chem 2010;56:892-5.  Back to cited text no. 1
    
2.Dalal BI, Brigden ML. Factitious biochemical measurements resulting from hematologic conditions. Am J Clin Pathol 2009;131:195-204.  Back to cited text no. 2
    
3.Weisbord SD, Chaudhuri A, Blauth K, DeRubertis FR. Monoclonal gammopathy and spurious hypophosphatemia. Am J Med Sci 2003;325:98-100.  Back to cited text no. 3
    



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