Recognizing hyperviscosity syndrome in patients with Waldenstrom macroglobulinemia

Area of Science:

• Hematology
• Oncology
• Internal Medicine

Background:

• Plasma cell dyscrasias, including Waldenstrom macroglobulinemia (WM), can lead to hyperviscosity syndrome.
• Waldenstrom macroglobulinemia is a rare B-cell malignancy marked by bone marrow infiltration and excessive monoclonal immunoglobulin M production.

Observation:

• Hyperviscosity syndrome presents with a characteristic triad of visual disturbances, neurological deficits, and bleeding tendencies.
• Elevated blood viscosity in WM is directly attributed to increased levels of circulating serum immunoglobulin M.

Findings:

• Early identification and intervention for hyperviscosity syndrome are critical due to its potentially lethal nature.
• Treatment strategies encompass hydration with diuresis, plasmapheresis to reduce viscosity, and targeted therapy for the underlying WM.

Implications:

• Effective management of hyperviscosity syndrome involves addressing both the immediate viscosity crisis and the underlying Waldenstrom macroglobulinemia with chemotherapy and rituximab.
• Oncology nurses are integral to the assessment and care of patients experiencing hyperviscosity syndrome, necessitating specialized knowledge for optimal patient outcomes.