Hyperviscosity syndrome

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