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hyperviscosity syndrome
Etiology:
1) polycythemia
2) cryoglobulinemia
3) diabetes mellitus
4) Waldenstrom's macroglobulinemia
5) multiple myeloma
6) acute myeloid leukemia
Pathology:
1) diminished blood through capillaries secondary to increased viscosity of the blood
2) thrombosis & infarction of tissues may occur
3) dysfibrinogenemia
Clinical manifestations:
1) dizziness
2) headache
3) lethargy, altered mental status
3) blurred vision
4) epistaxis & other mucosal bleeding may occur with platelet dysfunction
Laboratory:
- hypoxia
- arterial blood gas vs pulse oximetry
Special laboratory:
- funduscopy (images [4])
- dilated, tortuous, segmented retinal veins
Radiology:
- chest X-ray: diffuse infiltrates
Complications:
- hyperviscosity-related retinopathy [4]
Management:
1) general: plasmapheresis
2) specific measures directed at underlying pathology.
Related
cryoglobulinemia (cryoglobulinemic vasculitis)
diabetes mellitus
hyperviscosity
multiple myeloma; plasmacytoma/plasma cell myeloma
polycythemia
Waldenstrom's macroglobulinemia
General
hematologic disease (blood disorder, blood dyscrasia)
syndrome
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 527
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Medical Knowledge Self Assessment Program (MKSAP) 16, 19
American College of Physicians, Philadelphia 2012, 2022
- Kim W, Kweon E (images)
Hyperviscosity-Related Retinopathy in Waldenstrom's
Macroglobulinemia.
N Engl J Med 2016; 374:73. January 7, 2016
PMID: 26735995
http://www.nejm.org/doi/full/10.1056/NEJMicm1501103