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Hyperviscosity syndrome secondary to rheumatoid arthritis
L A Bach1, R R Buchanan, J D Scarlett
1Austin Hospital, Heidelberg, Vic, Australia.
Australian and New Zealand Journal of Medicine
|December 1, 1989
Summary
A woman with rheumatoid arthritis developed hyperviscosity syndrome, which improved with plasma exchange and corticosteroids. However, plasma exchange caused bleeding due to high immunoglobulin levels affecting coagulation and platelet function.
Area of Science:
- Rheumatology
- Hematology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Hyperviscosity syndrome is a rare complication characterized by increased blood viscosity.
Observation:
- A patient with established seropositive rheumatoid arthritis presented with gradual onset of hyperviscosity syndrome.
- The patient's condition initially responded to plasma exchange and corticosteroid therapy.
Findings:
- Plasma exchange, while effective for hyperviscosity, led to severe bleeding.
- Bleeding complications were linked to coagulation and platelet function disturbances.
- These hemostatic abnormalities correlated with significantly elevated plasma immunoglobulin levels.
Implications:
- This case highlights a rare but serious complication of rheumatoid arthritis.
- It underscores the potential risks of plasma exchange in patients with high immunoglobulin levels.
- Careful monitoring of coagulation and platelet function is crucial during plasma exchange for hyperviscosity syndrome in RA patients.