Treatment of hyperviscosity syndrome in the patients with plasma cell dyscrasias

A prospective study of 9 patients with plasma cell dyscrasia was performed to evaluate the need of plasma exchange (PE) and its possible effect in the acute and chronic management of hyperviscosity syndrome. The underlying dyscrasia was an IgG myeloma in 5 cases, IgA myeloma in 2 cases, one patient had IgD myeloma and in one patient Waldemström's macroglobulinemia was diagnosed. The main sequelae of circulatory disturbances, caused by increased blood resistance to flow, were fundus alterations (55.6%), neurologic manifestations (88.9%), a tendency to bleeding (44.4%) and renal failure (55.6%). In total, 49 PE procedures were performed. Following PE, hyperviscosity symptoms improved in 88.9% of the treated patients. The improvement in neurologic manifestations and hematologic complications was very fast, within the first PE session. The effect was less evident in ocular fundus alterations. Only one myeloma patient developed chronic renal failure. PE is the most effective method in the treatment of hyperviscosity syndrome often seen with multiple myeloma and Waldenström's macroglobulinemia, and it is therapy of choice for this complication.