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HWN Suggests

Hyperviscosity Syndrome

Increased immunoglobulin or blood cell production can lead to increased serum viscosity... Increased viscosity causes vascular stasis and the resultant hypoperfusion then leads to the clinical symptoms of HVS.

Avoid transfusion... a single unit of pRBCs may increase viscosity enough to cause worsening symptoms and clinical decompensation. If a transfusion is indicated, administer it by slow infusion. If plasma/cellular pheresis is not readily available and the patient is decompensating, one may try vigorous intravenous hydration coupled with a 2-3 unit phlebotomy in the interim as a temporizing measure.

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 Hyperviscosity Syndrome: EM-focused highlights

Immediate therapy of symptomatic hyperviscosity is directed at reduction of blood viscosity. Plasmapheresis is the initial treatment of choice for the management and stabilization of HVS, as it is usually safe for and well tolerated by the patient.

Articles of Interest

Blast Crisis: ED-focused management

With the rapid proliferation of cell lines, patients may present with signs of end organ damage, likely secondary to hyperviscosity, which can lead to end organ dysfunction and electrolyte abnormalities. Symptoms include but are not limited to bleeding, ocular, neurological, and cardiovascular problems.

Emergency Management of Blast Crisis

Increase in blast cells in the marrow results in blood hyperviscosity and relative reduction of other cell lines. If the patient has symptoms concerning for leukostasis and hyper viscosity (CNS changes, renal dysfunction, cardiovascular manifestations etc), emergent consult to Hematology should be made for possible leukopheresis.

Hyperviscosity Syndrome: an Update for Intensivists

Hyperviscosity syndrome (HS) is a clinical entity. It consists of various aspecific symptoms and its diagnosis relies on a set of contextual, anamnestic and clinico-biological arguments.

REBEL Core Cast 7.0 – Oncologic Emergencies

Hyperviscosity Syndrome happens when elevated WBCs or severe hyperproteinemia cause high serum viscosity and micro-circulatory problems in patients with Waldenstrom’s macroglobulinemia, multiple myeloma or acute leukemia.

When to Consider Plasmapheresis in the Emergency Department

Category I level IB recommendations are provided for hyperviscosity syndromes, while Category III level 1B recommendations are indicated for acute pancreatitis due to hypertriglyceridemia.

Resources

House Wiki

The extra density is usually from proteins, including increased numbers of white blood cells. This results in reduced blood flow to most of the body's organs, including the brain. It is generally characterized by increasingly severe neurological symptoms.

WikEM

Increased serum viscosity due to: Increased blood products (polycythemia, thrombocytosis, leukemia). Immunoglobulins (Waldenstrom's, IgA myeloma, multiple myeloma).

StatPearls

Hyperviscosity syndrome (HVS) is an oncologic emergency that classically presents with the triad of neurological deficits, visual changes, and mucosal bleeding.