Mini-report: Microcirculatory flow abnormalities in a patient with severe hyperviscosity syndrome

Area of Science:

• Hematology
• Nephrology
• Critical Care Medicine

Background:

• Waldenström Macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by IgM monoclonal gammopathy.
• Severe hyperviscosity syndrome can lead to end-organ damage, including acute kidney injury and neurological dysfunction.

Observation:

• A 60-year-old female presented with seizures, poor peripheral perfusion, and acute renal failure.
• Laboratory tests revealed hyperproteinemia, leading to diagnosis of WM with severe hyperviscosity.
• Sublingual microcirculation assessment showed sluggish, intermittent flow despite normal lactate and venous oxygen saturation.

Findings:

• Plasmapheresis was initiated, leading to a decrease in blood viscosity.
• Microvascular flow and the patient's clinical status improved concurrently with viscosity reduction.
• The patient was discharged from the ICU three days after the initial plasmapheresis treatment.

Implications:

• This case underscores the critical role of blood viscosity in determining microcirculatory flow.
• Effective management of hyperviscosity is crucial for improving outcomes in patients with WM.
• Videomicroscopy can be a valuable tool for assessing microvascular dysfunction in hyperviscosity syndromes.