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

A 60-year women was admitted to ICU because seizures, poor peripheral perfusion and acute renal failure. In laboratory tests an hyperproteinemia was detected, and therefore an electrophoresis and a bone marrow biopsy were performed, confirming a Waldenström Macroglobulinemia with severe hyperviscosity. Sublingual microcirculation was assessed with videomicroscopy, finding sluggish and intermittent microvascular flow, despite normal lactate and mixed venous O2 saturation. Promptly plasmapheresis was started, with viscosity decrease in parallel with improvement in microvascular flow and clinical status. Three days after the first plasmapheresis the patient was discharged from ICU. This case shows the critical role of viscosity on microcirculatory flow.