eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Hyperviscosity Syndrome: Follow-up

Author: Thomas J Hemingway, MD, BS, Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital
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; Douglas F Kupas, MD, Program Director, Department of Emergency Medicine, Geisinger Medical Center, Geisinger Health System
Contributor Information and Disclosures

Updated: Sep 12, 2008

Follow-up

Further Inpatient Care

  • Supportive care should be initiated for the complications of hyperviscosity syndrome pending definitive therapy. Care includes support for blood loss, central nervous system disorders, and cardiovascular effects, and metabolic derangements.
  • Note that the definitive treatment of hyperviscosity syndrome is treatment of the underlying disorder (eg, chemotherapy).

Transfer

  • Consider transfer if hematology/oncology consultation and plasma or cellular pheresis are unavailable at the treating facility.

Complications

  • Complications depend upon the underlying cause of the hyperviscosity.

Prognosis

  • Prognosis depends on the severity of the complications associated with hyperviscosity syndrome and the underlying cause of the hyperviscosity syndrome and the response of the appropriate definitive treatment. For example, multiple myeloma continues to have a poor long-term prognosis.

Patient Education

  • The diseases leading to hyperviscosity are chronic, and this condition may recur.
  • Patients and their families and/or caregivers should be educated about early signs and symptoms (eg, bleeding, visual symptoms, headache, mental status changes, shortness of breath).
 


More on Hyperviscosity Syndrome

Overview: Hyperviscosity Syndrome
Differential Diagnoses & Workup: Hyperviscosity Syndrome
Treatment & Medication: Hyperviscosity Syndrome
Follow-up: Hyperviscosity Syndrome
References
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References

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

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

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

  4. 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.

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

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

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

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

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

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

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

  12. 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].

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

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

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

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Further Reading

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Keywords

hyperviscosity syndrome, HVS, increased blood viscosity, increased serum viscosity, mucous membrane bleeding, retinopathy, Waldenström macroglobulinemia, multiple myeloma, leukemias, polycythemia, myeloproliferative disorders, plasma cell dyscrasias, paraproteinemias

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Contributor Information and Disclosures

Author

Thomas J Hemingway, MD, BS, Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital
Thomas J Hemingway, MD, BS 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, Program Director, Department of Emergency Medicine, Geisinger Medical Center, Geisinger Health System
Douglas F Kupas, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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