title: POEMS syndrome: importance of the clinical laboratory practitioner's role.
abstract: BACKGROUND
  Polyneuropathy organomegaly, endocrinopathy, monoclonal (M) gammopathy, skin syndrome (POEMS) may be difficult to diagnose as a result of methodological and clinical idiosyncrasies. Four of eleven criteria (M-protein, VEGF, endocrinopathy and thrombocytosis/polycythemia) are closely associated with clinical laboratory testing. POEMS has been largely associated with λ-M-gammopathies. Vascular endothelial growth factor (VEGF) is a recent addition to the major diagnostic criteria. VEGF may alter vascular permeability causing some manifestations of POEMS.
  
  
  METHODS
  Review of the literature that focuses on clinical laboratory issues--endocrinological findings, identification of monoclonal gammopathies by electrophoresis and case demonstration.
  
  
  RESULTS
  Based on the criterion of VEGF, POEMS was diagnosed in a patient with a κ-M-gammopathy.
  
  
  CONCLUSIONS
  Low-level IgA monoclonal proteins that are common in POEMS are often difficult to identify by serum electrophoresis (SPE). Immunofixation electrophoresis is required when polyneuropaties are investigated and an M-protein is not identified by SPE. VEGF may improve the sensitivity for diagnosis of POEMS and findings from capillary leak syndrome which are also associated with elevated VEGF and M-gammopathy suggests that κ-M-gammopathies may be implicated more often. It is demonstrated that due to computerized records, the laboratory practitioner is well suited to help the clinician make this complicated diagnosis.
authors: Department of Veterans Affairs, Robley Rex Medical Center, Louisville, KY 40206, USA. levinson@louisville.edu
authors: Stanley S
authors: SS
authors: Levinson
mesh_terms: D000368:Aged; D019559:Capillary Leak Syndrome / Q000209:etiology / Q000628:therapy; D005871:Castleman Disease / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D016878:POEMS Syndrome / Q000175:diagnosis*; D010265:Paraproteinemias / Q000150:complications / Q000209:etiology; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D006023:Glycoproteins; D042461:Vascular Endothelial Growth Factor A; C023587:protein M (glycoprotein)