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Licensed Unlicensed Requires Authentication Published by De Gruyter September 12, 2022

Analysis of cryoproteins with a focus on cryofibrinogen: a study on 103 patients

  • Patrizia Natali EMAIL logo , Daria Debbia , Maria R. Cucinelli , Tommaso Trenti , Gabriele Amati , Amelia Spinella , Dilia Giuggioli , Maria T. Mascia and Gilda Sandri

Abstract

Objectives

Cryofibrinogen (CF) is an abnormal protein in plasma that precipitates at 4 °C and dissolves at 37 °C. Whilst serum cryoglobulins (CGs) analysis is common practice, CF investigation is rarely performed. This study aims to describe the testing methodology developed at our laboratory, potential pitfalls for all analytical phases, the distribution among hospital wards and clinical conditions underlying test requests and clinical conditions in which to order CF analysis is useful.

Methods

Retrospective analysis of laboratory samples received between January 2019 and June 2021 with CF testing requests.

Results

A complete protocol for CF pre-analytical, analytical and post-analytical phases are supplied. Most test requests were received from the rheumatology department for systemic sclerosis or liver transplant screening. Among the 103 in-patients included, CF+ was confirmed in 68 patients (66%). Of observed CF+ patients (n=68) most cases were CGs− (n=44, 67%). Isolated CF was found in 43% of the cases. Among CF− patients (n=35; 34%) only 2 patients had positive CGs (CGs+). Among rheumatology patients (n=66), isolated CF+ was observed in 45% (n=30/66), whilst among patients with systemic sclerosis with CF+ (n=19), isolated CF+ was detected in 79% (n=15/19).

Conclusions

Described analytical procedures may be used for the creation of harmonized recommendations and indications for CF analysis. Isolated CF positivity among hospitalized patients, predominantly rheumatology and systemic sclerosis patients, appears higher than rates previously reported in literature. We propose CF test recommendations should be included in investigation protocols for diseases where cryofibrinogenemia may occur.


Corresponding author: Dr. Patrizia Natali, Department of Laboratory Medicine and Pathological Anatomy, Azienda Ospedaliero-Universitaria e Azienda USL di Modena, Ospedale Civile di Baggiovara, Via P. Giardini 1355, 41126 Modena, Baggiovara di Modena (MO), Italy, Phone: +39 059 3961077, E-mail:

Acknowledgments

We thank the Protein Unit technicians for their valuable contribution: Lucia Lezzi, Emanuela Lifonso, Gennaro Giannini, Claudia Collini, Angela Quagliarella, Lucia Mantuano and Cecilia Simonini.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: None declared.

  5. Ethical approval: None declared.

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Received: 2022-04-29
Accepted: 2022-08-31
Published Online: 2022-09-12
Published in Print: 2022-10-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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