This correlation may be useful for anticipating the need for repeat plasmapheresis. Serum viscosity and electrophoresis are recommended before and after plasmapheresis in order to correlate viscosity and M-spike with patient symptoms. Hyperviscosity syndrome can also occur in multiple myeloma patients.īecause the ability of a monoclonal protein to cause hyperviscosity is affected by its concentration, molecular weight, and aggregation, sera with concentrations of monoclonal IgM greater than 4 g/dL, IgA greater than 5 g/dL, or IgG greater than 6 g/dL should be tested for hyperviscosity. The most common cause of serum hyperviscosity is the presence of large concentrations of IgM monoclonal proteins, and Waldenstrom macroglobulinemia accounts for 80% to 90% of hyperviscosity cases. Funduscopic examination reveals dilation of retinal veins and flame shaped retinal hemorrhages. Hyperviscosity may be manifested by nasal bleeding, blurred vision, headaches, dizziness, nystagmus, deafness, diplopia, ataxia, paresthesias, or congestive heart failure. 2 Neonatal hyperviscosity, usually but not always associated with polycythemia.
A relative viscosity of 67 usually results in symptoms of the hyperviscosity syndrome, they have however been described with lower levels of relative viscosity (ie, 4). Viscosity is the property of fluids to resist flow. When IgG myeloma leads to hyperviscosity, IgG levels are usually very significantly elevated.
