Hyperviscosity syndrome

Background

  • Increased serum viscosity due to:
  • Symptoms arise from poor capillary flow and organ congestion

Clinical Features

Differential Diagnosis

Detailed differential can be found on each page

Oncologic Emergencies

Evaluation

Workup

  • CBC, coags, type and screen, chem 10
  • Urinalysis
  • CT head if neuro symptoms
  • CXR
  • Consider initiating inpatient testing with: Total protein, albumin, SPEP, UPEP, IgA, IgG, IgM
  • Note: ABGs might have SaO2 vs. SpO2 discrepancies
    • Causing spurious hypoxemia on ABG, with low PaO2 (as opposed to dyshemoglobinemia)
    • Due to "leukocyte larceny," "platelet larceny"[1][2][3]
    • Excessive O2 consumption by WBCs or platelets following blood sample collection

Evaluation

Symptoms of hyperviscosity can appear when one of the following occur:

  • Red cell mass > 25% of normal[4]
  • Platelets >600,000/┬ÁL[5]
  • Leukocytosis >100,000
  • Serum viscosity >4-5cP (normal 1.4-1.8cP)[6] or Globulin gap (Total protein - albumin) > 4

Management

  • ABCs
  • IVF, supportive care
  • Ig mediated/Dysproteinemia
  • Leukostasis
    • Leukapheresis
  • Thrombocytosis
    • Plateletpheresis
    • Consider ASA
  • Polycythemia
    • Phlebotomy
  • If pheresis is not unavailable, phlebotomize 2-3 units, give 2-3 L IVF

Disposition

  • Typically require admission if symptomatic
  • Hem/Onc consult

See Also

References

  1. Mehta A, Lichtin AE, Vigg A, Parambil JG. Platelet larceny: spurious hypoxaemia due to extreme thrombocytosis. Eur Respir J. 2008 Feb;31(2):469-72.
  2. Sacchetti A, Grynn J, Pope A, Vasso S. Leukocyte larceny: spurious hypoxemia confirmed with pulse oximetry. J Emerg Med. 1990 Sep-Oct;8(5):567-9.
  3. Lele AV, Mirski MA, Stevens RD. Spurious hypoxemia. Crit Care Med. 2005 Aug;33(8):1854-6.
  4. Pearson TC and Messinezy M. The diagnostic criteria of polycythaemia rubra vera. Leuk Lymphoma. 1999; 22 (1):87-93.
  5. Murphy S et al. Diagnostic criteria and prognosis in polycythemia vera and essential thrombocythemia. Semin Hematol. 1999; 36(1):9-13.
  6. Mehta J and Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost. 2003; 29(5):467-471.
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