Version June 2024
| Investigation | Common findings |
| Complete blood count (CBC) | Normal CBC, but anemia, thrombocytopenia, and thrombocytosis can be seen |
| Serum chemistry | Normal serum chemistry panel, but hypoalbuminemia and elevated lactate dehydrogenase can be seen |
| Acute phase reactants | Normal acute phase reactants, but elevated ESR, CRP, ferritin, and fibrinogen can be seen |
| SPEP, quantitative immunoglobulin, immunofixation, serum free light chains (FLC) | Normal with no M spike, normal serum FLC levels and ratio, IFE negative, but elevation in one or more immunoglobulin class (IgG, IgA, IgM) can be seen |
| Serum cytokine levels: IL-6 and VEGF (in select cases) | Normal cytokine levels, but elevated IL-6 and VEGF can be seen |
| Serological investigations for autoimmune disorders: only if clinically suspected | Normal serological tests for autoimmune disorders, but positive tests can be seen |
| Viral testing for HHV-8, HIV; if positive, quantitative assay. | Negative viral testing for HHV-8 and HIV and negative staining for HHV-8 in all cases. If PCR for HHV-8 of serum is positive or HHV-8 staining is positive, then HHV-8-associated MCD should be highly suspected and thoroughly investigated. |
| Imaging: PET/CT or CT of neck, chest, abdomen, and pelvis | Should only demonstrate enlarged/active lymph node(s) in one region of the body. The SUV should be 2.5 to 7. If there is more than one region of lymph node involvement, then iMCD should be investigated as an alternate diagnosis. If SUV uptake is >10, lymphoma should be investigated as an alternative diagnosis. |
| Histopathology and immunostaining | Lymph node histopathology consistent with hyaline vascular, plasmacytic, or mixed; negative staining of lymph node for EBER, LANA-1, and lymphoma or plasmacytoma markers if suspected |
| Clonality assessment | IgH gene rearrangement study on lymph node specimen should be negative, which rules out clonal disorder, mainly occult lymphoma |
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