Hyperviscosity syndrome: Difference between revisions
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===Evaluation=== | ===Evaluation=== | ||
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 | |||
==Management== | ==Management== | ||
Revision as of 00:15, 3 May 2016
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
- 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
Diagnosis
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
- Note: ABGs might have SaO2 vs. SpO2 discrepancies
- Causing spurious hypoxemia on ABG, with low PaO2 (as opposed to dyshemoglobinemia)
- Due to "leukocyte larceny," "platelet larceny"[1][2][3]
- Excessive O2 consumption by WBCs or plts following blood sample collection
Evaluation
Symptoms of hyperviscosity can appear when one of the following occur:
- Red cell mass > 25% of normal[4]
- Plt >600,000/µL[5]
- Leukocytosis >100,000
- Serum viscosity >4-5cP (normal 1.4-1.8cP)[6] or Globulin gap (Total protein - albumin) > 4
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 if symptomatic
- Hem/Onc consult
See Also
External Links
References
- ↑ Mehta A, Lichtin AE, Vigg A, Parambil JG. Platelet larceny: spurious hypoxaemia due to extreme thrombocytosis. Eur Respir J. 2008 Feb;31(2):469-72.
- ↑ Sacchetti A, Grynn J, Pope A, Vasso S. Leukocyte larceny: spurious hypoxemia confirmed with pulse oximetry. J Emerg Med. 1990 Sep-Oct;8(5):567-9.
- ↑ Lele AV, Mirski MA, Stevens RD. Spurious hypoxemia. Crit Care Med. 2005 Aug;33(8):1854-6.
- ↑ 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.