Hyperviscosity syndrome

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Background

  • Increased serum viscosity due to increased blood products or immunoglobulins
  • Causes: Waldenstrom's, IgA myeloma, polycythemia, leukemia

Symptoms

  • headache, blurred vision, AMS, focal neuro deficits
  • dyspnea, hypoxia, fever, fatigue
  • mucosal bleeding

Diagnosis

  • Elev. serum viscosity (>5cP)
  • Severe leukocytosis
  • Globulin gap (Total protein - albumin) > 4
Workup
  • Chem, CBC
  • Consider coags, UA
  • CT brain if neuro symptoms
  • CXR
Treatment
  • Plasmapharesis / Leukapharesis depending on cause
  • If unavailable, phlebotomize 2-3 units, give 2-3 L IVF
  • Supportive care
=Source=
  • Tintinalli 7th Ed.
  • Hemingway T. Hyperviscosity Syndrome. Medscape 2015
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