Mechanisms underlying tissue injury in cryoglobulinemic vasculitis

What are the mechanisms underlying tissue injury in cryoglobulinemic vasculitis?

• Cryoglobulin aggregation and precipitation can result in vascular occlusion, the predominant cause of injury in type I cryoglobulinemia. This reflects the large concentration and cold-inducible characteristics of the Igs in type I disease. Cold-inducible injury is not thought to play a major role in type II and type III MC, given the fact that in vitro cold precipitation is much slower.

• Immune complex-mediated vasculitis is the primary cause in type II and III MC. The small vessels are most commonly affected, but medium-vessel involvement may occur. Associated complement fixation partially explains the low level of complement in this condition. The higher the thermal range that the cryoglobulin will still precipitate, the more likely it is to activate complement.

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