Hyperviscosity Syndrome Clinical Presentation

  • Author: Thomas J Hemingway, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 10, 2012
 

History

Clinical symptoms generally are related to the triad of mucosal bleeding, visual changes, and neurologic symptoms.[2] Constitutional symptoms and cardiorespiratory symptoms also contribute to the clinical presentation.

  • The tendency to bleed is the most common symptom of hyperviscosity syndrome.
    • Spontaneous gum bleeding
    • Epistaxis
    • Rectal bleeding
    • Menorrhagia
    • Persistent bleeding after minor procedures
  • Visual changes range from blurred vision to vision loss.
  • Neurologic manifestations are frequent and varied. The neurologic symptoms of hyperviscosity have been referred to as the Bing-Neal syndrome.
    • Vertigo
    • Hearing loss
    • Paresthesias
    • Ataxia
    • Headaches
    • Seizures
    • Somnolence progressing to stupor and coma
  • Other manifestations may include heart failure, shortness of breath, hypoxia, fatigue, and anorexia.
  • In fact, one should have a high index of suspicion for HVS in patients with unexplained coma/altered mental status or unexplained shortness of breath especially in those with an underlying hematologic disorder.
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Physical

Physical findings are related to the major organ systems involved.

  • Bruises, epistaxis, or gum bleeding may be noted.
  • Ophthalmic examination may reveal decreased visual acuity, dilated retinal veins, "sausage-linked" or "boxcar segmentation" of the retinal veins, or retinal hemorrhages.
  • Neurologic examination may reveal various findings, including diminished mental status, confusion, ataxia, or nystagmus.
  • Cardiopulmonary examination may reveal signs of congestive heart failure with volume overload (rales, lower extremity edema, elevated JVP, and hypoxia).
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Causes

Increased serum viscosity usually results from increased circulating serum immunoglobulins and can be seen in Waldenström macroglobulinemia and multiple myeloma.

Less commonly, the hyperproliferative blood cell disorders such as the leukemias, myeloproliferative diseases, polycythemia, and thrombocytosis may be implicated for the increased viscosity caused by proliferation of their respective cellular components.

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Contributor Information and Disclosures
Author

Thomas J Hemingway, MD  Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital

Thomas J Hemingway, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Eric Alexander Savitsky, MD  Associate Clinical Professor of Medicine, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles Medical Center

Eric Alexander Savitsky, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Douglas F Kupas, MD  Associate Chief Academic Officer, Geisinger Health System; Assistant Dean for Medical Student Affairs, Temple University Geisinger Clinical Campus; Commonwealth EMS Medical Director, Pennsylvania Department of Health

Douglas F Kupas, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Behl D, Hendrickson AW, Moynihan TJ. Oncologic emergencies. Crit Care Clin. Jan 2010;26(1):181-205. [Medline].

  2. Adams BD, Baker R, Lopez JA, Spencer S. Myeloproliferative disorders and the hyperviscosity syndrome. Emerg Med Clin North Am. Aug 2009;27(3):459-76. [Medline].

  3. Blade J, Rosinol L. Complications of multiple myeloma. Hematol Oncol Clin North Am. Dec 2007;21(6):1231-46, xi. [Medline].

  4. Bloch KJ, Maki DG. Hyperviscosity syndromes associated with immunoglobulin abnormalities. Semin Hematol. Apr 1973;10(2):113-24. [Medline].

  5. Blum W, Porcu P. Therapeutic apheresis in hyperleukocytosis and hyperviscosity syndrome. Semin Thromb Hemost. Jun 2007;33(4):350-4. [Medline].

  6. D'Alessio T, Kupas DF. Altered mental status in a 57-year-old woman with multiple myeloma. Top Emerg Med. 1996;18(2):72-8.

  7. Drew MJ. Plasmapheresis in the dysproteinemias. Ther Apher. Feb 2002;6(1):45-52. [Medline].

  8. Fahey JL, Barth WF, Solomon A. Serum hyperviscosity syndrome. JAMA. May 10 1965;192:464-7. [Medline].

  9. Gertz MA, Kyle RA. Hyperviscosity syndrome. J Intensive Care Med. May-Jun 1995;10(3):128-41. [Medline].

  10. Higdon ML, Higdon JA. Treatment of oncologic emergencies. Am Fam Physician. Dec 1 2006;74(11):1873-80. [Medline].

  11. Hoffman R, et al. Therapy. In: Meloni D, Cox KJ, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Elsevier, Churchill, Livingstone; 2005.

  12. Hussein M. Multiple myeloma: an overview of diagnosis and management. Cleve Clin J Med. Jul-Aug 1994;61(4):285-98. [Medline].

  13. Kwaan HC, Bongu A. The hyperviscosity syndromes. Semin Thromb Hemost. 1999;25(2):199-208. [Medline].

  14. Kyle RA. Multiple myeloma: review of 869 cases. Mayo Clin Proc. Jan 1975;50(1):29-40. [Medline].

  15. Mehta J, Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost. Oct 2003;29(5):467-71. [Medline].

  16. Ovadia S, Lysyy L, Floru S. Emergency plasmapheresis for unstable angina in a patient with hyperviscosity syndrome. Am J Emerg Med. Oct 2005;23(6):811-2. [Medline].

  17. Rogers R. Emergencies in Hematology and Oncology - Subtle and Atypical presentations, pearls and pitfalls. EMedHome.com [web site].

  18. Rosen P, et al. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. Mosby Inc; 2002.

  19. Stone MJ, Bogen SA. Evidence-based focused review of management of hyperviscosity syndrome. Blood. Mar 8 2012;119(10):2205-8. [Medline].

  20. Zarkovic M, Kwaan HC. Correction of hyperviscosity by apheresis. Semin Thromb Hemost. Oct 2003;29(5):535-42. [Medline].

 
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