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Hyperviscosity Syndrome Clinical Presentation

  • Author: Thomas J Hemingway, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Nov 23, 2015
 

History

The clinical presentation of hyperviscosity syndrome consists principally of the triad of mucosal bleeding, visual changes, and neurologic symptoms.[1] Constitutional symptoms and cardiorespiratory symptoms also contribute to the clinical presentation.

The tendency to bleed is the most common manifestation of hyperviscosity syndrome. Patients may present with any of the following:

  • 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, and may include the following:

  • 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, the clinician should have a high index of suspicion for hyperviscosity syndrome in patients with unexplained coma/altered mental status or unexplained shortness of breath, especially in those with an underlying hematologic disorder. 

Blood hyperviscosity plays a role in the pathogenesis of several cardiovascular diseases, including hypertension, atherosclerosis,and the metabolic syndrome.[6]

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Physical

Physical findings are related to the major organ systems involved, as follows:

  • 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 abnormalities, 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 jugular venous pressure, 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, or 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, FACEP Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, Society for Academic Emergency Medicine

Disclosure: Securisyn Medical - serve on Advisory Board and own shares (<5%).

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.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American College of Physicians

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 Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
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