Hyperviscositiy syndrome

Question 1

What are the symptoms of hyper viscosity

Answer 1

Lethargy
Confusion 
Decreased cognition 
CNS disturbance
Chest pain
Abdo pain - GI/GU bleeding
Faints
Decreased vision
Amaurosis fugax 
Retinopathy - engorged retinal veins, haemorrhages, exudates, blurred disc

Question 2

What can cause high blood viscosity

Answer 2

Very high RBC count - haematocrit >50 in conditions such as polycythaemia vera
Very high WCC - >100, such as in leukaemia
Plasma components such as immunoglobulins in myeloma and waldenstroms macroglobinemia
Drugs - COPC, Diuretics, IVIG, chemo, radio-contrast media

Question 3

What is the treatment for Hyperviscositiy

Answer 3

Treat the cause urgently
Venesection in polycythaemia
Leukapharesis in leukaemia
Plasmapheresis in myeloma and waldenstroms