Hyperviscosity syndrome: Difference between revisions
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==Disposition== | ==Disposition== | ||
*Typically | *Typically require admission is symptomatic | ||
*Hem/Onc consult | *Hem/Onc consult | ||
Revision as of 14:33, 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 require admission is symptomatic
- 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.