Clinical Information

Viscosity is the property of fluids to resist flow. Hyperviscosity may be manifested by nasal bleeding, blurred vision, headaches, dizziness, nystagmus, deafness, diplopia, ataxia, paresthesias, or congestive heart failure. Funduscopic examination reveals dilation of retinal veins and flame shaped retinal hemorrhages.

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. Hyperviscosity syndrome can also occur in multiple myeloma patients.

Because 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.

Serum viscosity and electrophoresis are recommended before and after plasmapheresis in order to correlate viscosity and M-spike with patient symptoms. This correlation may be useful for anticipating the need for repeat plasmapheresis.