Question: I am having a problem with unsightly purpura and swelling (some achiness) at the base of my left thumb and across my wrist for the past approximately 1 1/2 years now. The veins on the top of this hand also appear much larger and protruding than my other hand. The purpura remains for a few months and when it is almost faded I will wake up in the morning and it is back again! I have a history of CAD and also heart attacks and am on Plavix and low dose asa for about 15 years now but the purpura started only 1 1/2 years ago. I first asked my cardiologist about it last year but he said it was from the medications and not to worry about it (but the kind of purpura he is referring to appears here there and everywhere, not the exact same place repeatedly just like old age purpura does). I am seeing an oncologist every 3 months (for blood tests) for the past year or so because I have an elevated IGM (in the bone marrow also). She is supposedly and oncologist/hemotologist and told me that this will most likely turn into Waldenstroms in the next decade if not sooner. I asked her about the purpura because I have read there is something called Waldenstrom purpura that always appears in the same location. She confirmed this but said it is puzzleing because My IGM is not elevated enough to be Waldenstroms yet. I have also seen a orthopedic hand surgeon that says there are no broken bones in the wrist or arthritis and a referal to a rheumatologist showed no arthritis during blood testing. This is a VERY frustrating situation. Do you have any idea what it could be or what type of specialist I should be seeing? I can give you any lab result information you may want.

I sent you a reply and question but I cannot tell uif it went through. Please advise

I think you might need these lab results to answer my question:

My IGA & IGG are always within normal range. My IGM has been elevated & fluctuating between 418 & 665 since Oct 2012 with this months being 581. Free Kappa also elevated fluctuating between 20.5 & 23.3 with this months being 20.8. Free Lambda 26.4 to 29.0 with this months beibng 29.0. Free Kappa/Lambda ration has always been within range since Oct 2012, 0.72-0.85 with this months being 0.72. Serum Immunofixation in May of 2013 showed a faint IGM (lambda) monoclonal immunoglobulin but all above results were on a polyclonal backround. Bone marrow biopsy in May of 2013 showed a 3% plasma cell increase with increased lambda production. All other bloodwork pretty much in normal ranges and my rheumatoid factor is within normal range. I did loose a kidney about 2 yrs ago but nobody knows why (it was attributed to "an unknown metabolic occurence". My GFR fluctuates between 58 & 60 which the nephrologist says is fine for my age and there is no protien in my urine. I have CAD (familial) and in the past 15 yrs have had 6 heart attacks, a number of angioplasties and a stent. I am doing fine on Plavix, asa, crestor, losartan & toprol and have not had another heart attack in over 3 years. I am a perfect weight 5'2" and 110 lbs, eat a very healthy cardiac/renal diet, exercise daily and people think I'm crazy when they hear about all of these medical problems I have. I look and feel perfectly healthy.

All of the articles I have found say hypergammaglobulinemic purpura of Waldenström affects the lower limbs. My legs are fine (not even any edema), it's just my left wrist and arm. This has me totally baffled. In your opinion do these numbers really mean I will DEFINATELY get Waldenstroms in the next 6 years or so like I was told? I know anything is possible but WM is pretty rare. Is it because of the immunofixation that makes it definate for WM ay some point in time?

OOOPS, those numbers are all mg no G. Sorry about that

Thanks for the info on Hirudoid cream. Unfortunately I cannot get it our here in the US but do have a compounding pharmacy close by that will probably work with me. I do have one concern though since this cream is 3% heparinoid. Is there any risk factor since I am taking plavix 50mg and 81mg asa daily? I asked some pharmacists today but they could not advise me because they have never even heard of Hirudoid cream.