Acute hyperviscosity: syndromes and management

Area of Science:

• Hematology
• Immunology
• Clinical Medicine

Background:

• Plasma hyperviscosity is a rare condition linked to elevated immunoglobulin levels in monoclonal and polyclonal disorders.
• Whole-blood hyperviscosity can occur with significantly high red blood cell and white blood cell counts.

Observation:

• Asymptomatic patients with elevated serum viscosity generally do not require immediate plasma exchange.
• Hemorrhagic or central nervous system symptoms are key indicators for plasma exchange therapy.
• Viscosity measurements are not mandatory for initiating treatment if clinical suspicion is high.

Findings:

• Plasma exchange is the preferred and safe treatment for symptomatic hyperviscosity, especially with neurological or bleeding complications.
• Phlebotomy is an established therapy for whole-blood hyperviscosity due to extreme red or white blood cell elevations.

Implications:

• Early recognition of clinical manifestations can guide timely and appropriate therapeutic interventions for hyperviscosity syndromes.
• This approach ensures efficient management, reserving intensive treatments for patients who will benefit most.