Hyperviscosity syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Increased serum viscosity due to | *Increased serum viscosity due to: | ||
* | *#Increased blood products (polycythemia, thrombocytosis. leukemia) | ||
*#Immunoglobulins (Waldenstrom's, IgA myeloma, multiple myeloma) | |||
*Symptoms arise from poor capillary flow and organ congestion | |||
== | ==Clinical Features== | ||
* | *Symptoms of hyperviscosity can appear when one of the following occur: | ||
* | **Red cell mass > 25% of normal<ref>Pearson TC and Messinezy M. The diagnostic criteria of polycythaemia rubra vera. Leuk Lymphoma. 1999; 22 (1):87-93.</ref> | ||
* | **Plt >600,000/µL<ref>Murphy S et al. Diagnostic criteria and prognosis in polycythemia vera and essential thrombocythemia. Semin Hematol. 1999; 36(1):9-13.</ref> | ||
**Leukocytosis >100,000 | |||
**Serum viscosity >4-5cP (normal 1.4-1.8cP)<ref>Mehta J and Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost. 2003; 29(5):467-471.</ref> or Globulin gap (Total protein - albumin) > 4 | |||
==Diagnosis== | ===Symptoms=== | ||
* | *Gen: fever, fatigue | ||
* | *CNS: headache, blurred vision, AMS, focal neuro deficits | ||
* | *Pulm: dyspnea, hypoxia | ||
*Cardiac: chest pain, CHF | |||
*Hem: mucosal bleeding | |||
==Differential Diagnosis== | |||
''Detailed DDx can be found on each page'' | |||
*[[Stroke]] | |||
*[[Altered mental status]] | |||
*[[Chest pain]] | |||
*[[Hypoxemia]] | |||
*[[Dyspnea]] | |||
==Workup== | ==Workup== | ||
*Chem | *CBC | ||
* | *Chem 10 | ||
*Coags | |||
*Type and screen | |||
*UA | |||
*CT brain if neuro symptoms | *CT brain if neuro symptoms | ||
*CXR | *CXR | ||
*Consider initiating inpatient testing with: Total protein, albumin, SPEP, UPEP, IgA, IgG, IgM | |||
==Management== | |||
*ABCs | |||
*IVF and supportive care | |||
*Ig mediated | |||
**Plasmapharesis | |||
*Leukostasis | |||
**Leukopheresis | |||
*Thrombocytosis | |||
**Plateletpheresis | |||
**Consider ASA | |||
*Polycythemia | |||
**Phlebotomy | |||
*If pheresis is not unavailable, phlebotomize 2-3 units, give 2-3 L IVF | |||
==Disposition== | |||
*Typically need admission | |||
*Hem/Onc consult | |||
==See Also== | |||
== | ==External Links== | ||
== | ==Sources== | ||
<references/> | |||
Revision as of 14:32, 8 March 2015
Background
- Increased serum viscosity due to:
- Increased blood products (polycythemia, thrombocytosis. leukemia)
- Immunoglobulins (Waldenstrom's, IgA myeloma, multiple myeloma)
- Symptoms arise from poor capillary flow and organ congestion
Clinical Features
- Symptoms of hyperviscosity can appear when one of the following occur:
Symptoms
- Gen: fever, fatigue
- CNS: headache, blurred vision, AMS, focal neuro deficits
- Pulm: dyspnea, hypoxia
- Cardiac: chest pain, CHF
- Hem: mucosal bleeding
Differential Diagnosis
Detailed DDx can be found on each page
Workup
- CBC
- Chem 10
- Coags
- Type and screen
- UA
- CT brain if neuro symptoms
- CXR
- Consider initiating inpatient testing with: Total protein, albumin, SPEP, UPEP, IgA, IgG, IgM
Management
- ABCs
- IVF and supportive care
- Ig mediated
- Plasmapharesis
- Leukostasis
- Leukopheresis
- Thrombocytosis
- Plateletpheresis
- Consider ASA
- Polycythemia
- Phlebotomy
- If pheresis is not unavailable, phlebotomize 2-3 units, give 2-3 L IVF
Disposition
- Typically need admission
- Hem/Onc consult
See Also
External Links
Sources
- ↑ Pearson TC and Messinezy M. The diagnostic criteria of polycythaemia rubra vera. Leuk Lymphoma. 1999; 22 (1):87-93.
- ↑ Murphy S et al. Diagnostic criteria and prognosis in polycythemia vera and essential thrombocythemia. Semin Hematol. 1999; 36(1):9-13.
- ↑ Mehta J and Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost. 2003; 29(5):467-471.