Hyperviscosity syndrome is a group of symptoms triggered by increase in the viscosity

Viscosity

Viscosity is a measure of the resistance of a fluid which is being deformed by either shear or tensile stress. In everyday terms , viscosity is "thickness" or "internal friction". Thus, water is "thin", having a lower viscosity, while honey is "thick", having a higher viscosity...

 of the blood

Blood

Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

. Symptoms of high blood viscosity

Blood viscosity

Blood viscosity is a measure of the resistance of blood to flow, which is being deformed by either shear or extensional strain.Blood is a liquid that consists of plasma and particles, such as the red blood cells. The viscosity of blood thus depends on the viscosity of the plasma, in combination...

 include spontaneous bleeding from mucous membrane

Mucous membrane

The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...

s, visual disturbances due to retinopathy

Retinopathy

Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease.-Pathophysiology:Causes of retinopathy are varied:...

, and neurologic symptoms ranging from headache

Headache

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

 and vertigo

Vertigo (medical)

Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear...

 to seizures and coma

Coma

In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...

.

Hyperviscosity syndrome may be caused by an increase in serum

Blood plasma

Blood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...

 proteins or cells. Increased levels of proteins are seen with monoclonal gammopathies

Monoclonal gammopathy

Monoclonal gammopathy is a synonym for paraproteinemia.- External links :*...

 such as Waldenström macroglobulinemia

Waldenström macroglobulinemia

Waldenström's macroglobulinemia is cancer involving a subtype of white blood cells called lymphocytes. The main attributing antibody is Immunoglobulin M . WM is an "indolent lymphoma,"...

 and in multiple myeloma

Multiple myeloma

Multiple myeloma , also known as plasma cell myeloma or Kahler's disease , is a cancer of plasma cells, a type of white blood cell normally responsible for the production of antibodies...

 (particularly IgA and IgG3). High cell counts are seen in conditions such as polycythemia

Polycythemia

Polycythemia is a disease state in which the proportion of blood volume that is occupied by red blood cells increases...

 (raised red blood cell

Red blood cell

Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...

s) or leukemia

Leukemia

Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...

 (more white blood cell

White blood cell

White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...

s, especially in acute leukemic blast crises).

Diagnosis

Serum viscosity can be measured. Normal is between 1.4 and 1.8 centipoises but to have symptoms from hyperviscosity, serum viscosity is usually greater than 5 centipoises. Patients will also have evidence of their underlying disorder. Those with myeloma will typically display a rouleaux

Rouleaux

Rouleaux are stacks of red blood cells which form because of the unique discoid shape of the cells in vertebrate body. The flat surface of the discoid RBCs give them a large surface area to make contact and stick to each other; thus, forming a rouleau...

 formation on a peripheral smear and a large globulin

Globulin

Globulin is one of the three types of serum proteins, the others being albumin and fibrinogen. Some globulins are produced in the liver, while others are made by the immune system. The term globulin encompasses a heterogeneous group of proteins with typical high molecular weight, and both...

 gap, indicative of a significant paraprotein

Paraprotein

A paraprotein is an immunoglobulin or immunoglobulin light-chain that is produced in excess by the clonal proliferation of plasma cells. Detection of paraproteins in the urine or blood is most often associated with benign MGUS , where they remain "silent", and multiple myeloma. An excess in the...

 load. While viscosity can be directly measured, results can take a few days to return and thus a high index of suspicion is required to make the diagnosis in a timely manner. If hyperviscosity is suspected, treatment may need to be started prior to obtaining the official viscosity level.

Treatment

Plasmapheresis

Plasmapheresis

Plasmapheresis is the removal, treatment, and return of blood plasma from blood circulation. It is thus an extracorporeal therapy...

 may be used to decrease viscosity in the case of myeloma, whereas leukapheresis

Leukapheresis

Leukapheresis is a laboratory procedure in which white blood cells are separated from a sample of blood. It is a specific type of apheresis, the more general term for separating out one particular constituent of blood and returning the remainder to the circulation.Leukapheresis may be performed to...

 or phlebotomy

Phlebotomy

Phlebotomy is the process of making an incision in a vein.It is associated with the following concepts:* Venipuncture, the practice of collecting venous blood samples* The main practice of a phlebotomist, an individual trained to draw blood...

 may be employed in a leukemic or polycythemic crisis, respectively. Blood transfusion

Blood transfusion

Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...

s should be used with caution as they can increase serum viscosity. Hydration is a temporizing measure to employ while preparing pheresis. Even after treatment, the condition will recur unless the underlying disorder is treated.

External links

- "Hyperviscosity - newborn"