Cryoglobulinemia can be suspected by changes seen in the peripheral blood smear.
Red blood cells may resemble schistocytes or acanthocytes. These can be found in the absence of hemolysis (normal serum LDH, normal serum haptoglobin) but could also reflect a hemolytic anemia. These may be more pronounced with cryoglobulinemic vasculitis.
Rouleaux may be present.
The background of the smear may show:
(1) amorphous precipitate of cryoprotein, especially if the specimen is cooled.
(2) extracellular crystals of cryoprotein.
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