{
  "schemaVersion": 2,
  "eyebrow": "Hematologic emergency",
  "title": "Hyperviscosity Syndrome",
  "summary": "Treat symptomatic hyperviscosity as an oncologic emergency: recognize retinal, mucosal bleeding, neurologic, and cardiopulmonary injury; obtain viscosity and cause-directed studies without delaying plasma exchange; then suppress the responsible paraprotein-producing or leukemic process.",
  "seoDescription": "Physician guide to recognizing hyperviscosity syndrome, differentiating paraprotein disease from leukostasis, and initiating urgent plasma exchange.",
  "clinicalQuestion": "How should physicians identify, stabilize, and definitively manage symptomatic hyperviscosity syndrome?",
  "specialty": "Hematology and emergency medicine",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "hyperviscosity syndrome",
    "serum viscosity",
    "Waldenstrom macroglobulinemia",
    "plasmapheresis",
    "therapeutic plasma exchange",
    "multiple myeloma",
    "leukostasis",
    "cryoglobulinemia"
  ],
  "keyTakeaways": [
    "New mucosal bleeding, visual disturbance, or neurologic dysfunction in a patient with suspected or known paraproteinemia warrants urgent evaluation for symptomatic hyperviscosity and should not await a viscosity result before therapeutic plasma exchange. [3][18][24]",
    "Serum viscosity above 4 relative to water is commonly associated with symptomatic hyperviscosity, but individual symptom thresholds vary and retinal disease may occur at lower serum viscosity or IgM levels. [1][7][8]",
    "Waldenstrom macroglobulinemia is the predominant paraprotein-associated cause; symptomatic hyperviscosity is less common in IgG- or IgA-associated myeloma. [16][18][23]",
    "Therapeutic plasma exchange rapidly removes circulating paraprotein but does not control the clone; start disease-directed cytoreduction concurrently to prevent recurrence. [18][23]",
    "Separate paraprotein hyperviscosity from leukostasis: symptomatic hyperleukocytosis requires immediate cytoreduction, isotonic fluids, and avoidance of nonessential red-cell transfusion while the leukocyte count remains high. [17][19][23]"
  ],
  "sections": [
    {
      "id": "recognize-and-triage",
      "eyebrow": "Immediate decision",
      "heading": "When to treat as hyperviscosity syndrome",
      "intro": "Act on a compatible clinical syndrome rather than a laboratory value alone.",
      "paragraphs": [
        "Hospitalize patients with a compatible syndrome and immediately involve hematology plus an apheresis-capable center. The classic high-risk pattern is mucosal bleeding, retinal or visual symptoms, and neurologic dysfunction; reported manifestations also include blurred vision, retinal hemorrhage, headache, vertigo, hearing change, ataxia, confusion, seizures, somnolence, coma, dyspnea, and heart failure. [3][16][23][24]",
        "Obtain serum viscosity before exchange when doing so does not delay treatment, but do not use one numeric threshold to exclude symptomatic disease. Relative serum viscosity is normally about 1.4 to 1.8 times water; symptoms often emerge around 4 to 7, and a value greater than 4 is commonly associated with hyperviscosity syndrome. Clinical thresholds vary substantially, particularly with coexisting retinal disease, and Waldenstrom-related retinopathy can occur at lower serum IgM and viscosity levels than historically expected. [1][7][8]",
        "Perform urgent funduscopic examination when visual complaints, headache, or bleeding accompany a suspected paraproteinemia. Retinal venous congestion, hemorrhages around small retinal vessels, papilledema, and segmented “sausage-like” venous changes support impaired retinal microcirculation and provide a bedside marker of response to plasma exchange. [16][18]"
      ],
      "bullets": [
        "Escalate immediately for declining consciousness, focal neurologic deficits, seizure, rapidly worsening vision, major bleeding, hypoxemia, or acute heart failure; these findings represent threatened end-organ perfusion or capillary injury. [16][20][24]",
        "Give crystalloid promptly if dehydration is present or suspected because dehydration worsens hyperviscosity. [23]",
        "Do not defer therapy for a high IgM or serum viscosity value in an otherwise asymptomatic patient; hyperviscosity syndrome is the clinical manifestation of increased viscosity, and symptom correlation is imperfect. [1][12][16]"
      ],
      "subsections": [],
      "table": {
        "caption": "Syndrome features that should trigger urgent serum viscosity testing and apheresis planning. [3][16][18][24]",
        "columns": [
          "Organ system",
          "Actionable findings",
          "Immediate implication"
        ],
        "rows": [
          [
            "Eye",
            "Blurred vision, visual loss, retinal hemorrhage, venous congestion, papilledema [3][16][18]",
            "Urgent fundus examination; organize plasma exchange when findings are compatible with symptomatic hyperviscosity. [18]"
          ],
          [
            "Neurologic",
            "Headache, vertigo, ataxia, diplopia, confusion, seizure, somnolence, coma [16][24]",
            "Treat as a microcirculatory emergency while assessing alternate neurologic diagnoses. [16][20][24]"
          ],
          [
            "Bleeding",
            "Epistaxis or other mucous-membrane bleeding [3][24]",
            "Assess for paraproteinemia and urgent plasma exchange indication. [3][18]"
          ],
          [
            "Cardiopulmonary",
            "Dyspnea or heart failure [16][24]",
            "Assess volume status and end-organ compromise; avoid worsening dehydration while arranging definitive therapy. [23][24]"
          ]
        ]
      }
    },
    {
      "id": "diagnostic-branching",
      "eyebrow": "Etiologic branching",
      "heading": "Identify whether viscosity is driven by paraprotein, cells, or cryoprotein",
      "intro": "The cause determines the apheresis target and definitive treatment pathway.",
      "paragraphs": [
        "For suspected serum hyperviscosity, send serum viscosity, serum protein studies to identify a monoclonal immunoglobulin, complete blood count, and basic organ assessment while arranging treatment for symptomatic patients. Markedly elevated Westergren erythrocyte sedimentation rate and increased serum immunoglobulins are supportive clues, but neither substitutes for serum viscosity or clinical assessment. [1][22]",
        "Waldenstrom macroglobulinemia is the most frequent plasma-cell-dyscrasia context for symptomatic hyperviscosity because IgM overproduction promotes erythrocyte aggregation and impaired microvascular flow. Hyperviscosity occurs more often in Waldenstrom macroglobulinemia, reported at 10% to 30%, than in IgG- or IgA-associated myeloma, reported at 2% to 6%. [16][18][23]",
        "Multiple myeloma remains an important alternative when a monoclonal protein accompanies anemia, marrow failure, kidney injury, or bone disease. Hyperviscosity is uncommon in myeloma but can cause epistaxis, blurred vision, retinal hemorrhage, neurologic symptoms, dyspnea, and heart failure; treat symptomatic cases as an emergency with immediate plasmapheresis. [10][24]",
        "When serum becomes visibly gel-like on cooling and reversibly liquefies with warming, consider cryoglobulinemia as the cause of hyperviscosity. In this branch, rapidly evolving life-threatening disease is an indication for plasmapheresis, while the underlying cryoglobulinemic process requires cause-directed management. [5][18]",
        "Do not conflate paraprotein hyperviscosity with leukostasis. Leukostasis is symptomatic hyperleukocytosis with neurologic and/or pulmonary manifestations; hyperleukocytosis is generally defined as a white blood cell count greater than 100,000 cells/μL. Whole-blood rather than serum viscosity is relevant when cellular burden is suspected, and acute leukemia requires immediate cytoreductive management. [17][19][22]"
      ],
      "bullets": [
        "In a patient with suspected Waldenstrom macroglobulinemia, obtain serum viscosity even if the IgM concentration appears only moderately elevated when visual or neurologic symptoms are present. [7][8]",
        "In suspected leukostasis, prioritize white blood cell count, blast evaluation, pulmonary and neurologic assessment, and immediate hematology-directed cytoreduction rather than plasma exchange as the primary intervention. [17][19]",
        "A patient with hyperviscosity symptoms and an atypical neurologic presentation in an IgM-associated malignancy may have a CNS complication such as Bing-Neel syndrome; do not attribute persistent neurologic findings solely to viscosity after plasma exchange. [16]"
      ],
      "subsections": [],
      "table": {
        "caption": "Etiologic patterns that redirect emergency management. [5][16][17][18][19][23]",
        "columns": [
          "Pattern",
          "Discriminators",
          "Immediate management priority",
          "Definitive direction"
        ],
        "rows": [
          [
            "Waldenstrom macroglobulinemia",
            "IgM-associated paraproteinemia with retinal, bleeding, or neurologic syndrome; most common paraprotein-associated setting [16][23]",
            "Therapeutic plasma exchange for symptomatic hyperviscosity [18][23]",
            "Concurrent hematology-directed cytoreductive therapy to prevent recurrence [18][23]"
          ],
          [
            "IgG or IgA myeloma",
            "Monoclonal protein with myeloma features; symptomatic hyperviscosity is less frequent than in Waldenstrom macroglobulinemia [10][16]",
            "Immediate plasmapheresis when symptomatic [18][24]",
            "Myeloma-directed systemic therapy [18][24]"
          ],
          [
            "Cryoglobulinemia",
            "Reversible serum gel formation with cooling and warming [5]",
            "Plasmapheresis for rapidly evolving life-threatening disease [18]",
            "Treat the causative cryoglobulinemic disorder [18]"
          ],
          [
            "Leukostasis",
            "Symptomatic hyperleukocytosis, often with neurologic and pulmonary manifestations; white blood cell count generally greater than 100,000 cells/μL [17][19]",
            "Isotonic fluids, emergency cytoreduction, tumor-lysis monitoring; limit red-cell transfusion unless symptomatic anemia requires it [17]",
            "Acute leukemia-directed therapy [17][19]"
          ]
        ]
      }
    },
    {
      "id": "therapeutic-plasma-exchange",
      "eyebrow": "Acute treatment",
      "heading": "Start plasma exchange promptly for symptomatic paraprotein hyperviscosity",
      "intro": "Therapeutic plasma exchange is a bridge to clone-directed therapy, not definitive cancer control.",
      "paragraphs": [
        "Initiate therapeutic plasma exchange as soon as possible for symptomatic paraprotein-mediated hyperviscosity. It rapidly lowers circulating paraprotein and can relieve clinical manifestations, including retinal microcirculatory compromise; early exchange may reduce blindness from retinal hemorrhage or retinal detachment. [18][23]",
        "Use albumin replacement in routine exchanges: 4% to 5% human albumin in physiologic saline is commonly used. Consider fresh frozen plasma when a coagulation abnormality requires factor replacement. [18]",
        "Repeat exchange based on persistent symptoms, retinal findings, and paraprotein burden rather than a single postprocedure number. In IgM-associated hyperviscosity, one to three daily procedures generally abate acute symptoms; IgG-associated hyperviscosity may require more procedures because removal is less efficient. [18]",
        "Document response clinically after each procedure, with repeat retinal examination when ocular findings were present. Serum paraprotein measurement provides an objective adjunct, but acute treatment should be continued until the clinical syndrome abates. [18]"
      ],
      "bullets": [
        "Do not use plasma exchange as sole treatment: it does not eradicate the underlying malignancy and recurrence is expected without cytoreduction. [18][23]",
        "For active symptomatic hyperviscosity, begin disease-specific systemic treatment concurrently with plasma exchange under hematology direction. [18][23]",
        "In myeloma, bortezomib and carfilzomib are cited as agents that can rapidly reduce viscosity; in the appropriate hematologic context, ibrutinib is also cited as a rapidly acting cytoreductive option. Regimen selection depends on the underlying disease and hematology assessment. [23]"
      ],
      "subsections": [],
      "table": {
        "caption": "Procedure-focused monitoring for paraprotein-mediated symptomatic hyperviscosity. [18][23]",
        "columns": [
          "Time point",
          "Assess",
          "Action"
        ],
        "rows": [
          [
            "Before first exchange",
            "Bleeding, visual, neurologic, pulmonary, and heart-failure manifestations; serum viscosity and paraprotein burden when this does not delay treatment [18][23]",
            "Arrange urgent therapeutic plasma exchange and start concurrent hematology-directed therapy. [18][23]"
          ],
          [
            "After each exchange",
            "Symptoms, funduscopic findings when initially abnormal, and paraprotein level as an objective adjunct [18]",
            "Continue daily exchange if acute manifestations persist. [18]"
          ],
          [
            "After symptom control",
            "Evidence of recurrent visual, neurologic, or mucosal bleeding symptoms [3][18]",
            "Maintain disease-directed therapy because plasma exchange alone does not prevent recurrence. [18][23]"
          ]
        ]
      }
    },
    {
      "id": "supportive-care-and-exceptions",
      "eyebrow": "Avoid preventable worsening",
      "heading": "Support microvascular perfusion while avoiding diagnosis-specific errors",
      "intro": "Supportive interventions differ materially between paraprotein hyperviscosity and leukostasis.",
      "paragraphs": [
        "Correct dehydration with crystalloid in suspected hyperviscosity because volume depletion increases viscosity and can worsen end-organ hypoperfusion. Monitor cardiopulmonary status closely in patients with dyspnea or heart failure manifestations, where fluid administration requires individualized balance. [16][23][24]",
        "For leukostasis or marked hyperleukocytosis, use isotonic fluid resuscitation to reduce viscosity and maintain urine output while initiating emergency cytoreduction and tumor-lysis monitoring. Avoid diuretics unless clinically important volume overload is present. [17]",
        "Avoid routine red-cell transfusion before leukocyte reduction in hyperleukocytosis because increasing hematocrit can increase blood viscosity and worsen leukostasis; reserve transfusion for symptomatic anemia. This caution is specific to the cellular hyperviscosity branch and should not delay treatment of clinically significant anemia when necessary. [17]"
      ],
      "bullets": [
        "Reassess neurologic deficits after viscosity reduction; persistent or focal findings require evaluation for competing CNS pathology, including CNS complications of IgM-associated disease. [16][20]",
        "Use both serum and whole-blood viscosity determinations when hyperviscosity-associated cognitive decline is suspected and the contribution of cellular versus serum factors is uncertain. [22]",
        "Do not use absence of a universal serum viscosity threshold to reassure a symptomatic patient; comorbid disease, including diabetic retinopathy, can lower the threshold for clinical manifestations. [1]"
      ],
      "subsections": [],
      "table": {
        "caption": "Management distinctions that prevent treating the wrong viscosity syndrome. [17][18][23]",
        "columns": [
          "Decision",
          "Paraprotein hyperviscosity",
          "Leukostasis/hyperleukocytosis"
        ],
        "rows": [
          [
            "Primary emergency intervention",
            "Therapeutic plasma exchange to remove circulating paraprotein [18][23]",
            "Prompt cytoreductive chemotherapy; leukapheresis has an uncertain role in preventing complications or induction death in pediatric evidence summarized in review literature. [17]"
          ],
          [
            "Fluid strategy",
            "Prompt crystalloid when dehydration is suspected [23]",
            "Isotonic fluids to reduce viscosity and maintain urine output [17]"
          ],
          [
            "Red-cell transfusion",
            "Individualize to clinical need",
            "Limit until white blood cell count is reduced unless symptomatic anemia requires transfusion. [17]"
          ],
          [
            "Recurrence prevention",
            "Disease-specific systemic therapy concurrent with exchange [18][23]",
            "Definitive acute leukemia therapy and tumor-lysis prophylaxis/monitoring [17]"
          ]
        ]
      }
    }
  ],
  "faq": [
    {
      "question": "Should plasma exchange wait for a serum viscosity result?",
      "answer": "No. In a patient with a compatible symptomatic paraprotein-associated syndrome, initiate urgent plasma exchange planning and treatment without waiting for the result; serum viscosity supports diagnosis and monitoring, but symptom thresholds vary. [1][18][23][24]"
    },
    {
      "question": "How many plasma exchange procedures are usually required?",
      "answer": "For IgM-associated hyperviscosity, one to three daily procedures generally relieve acute symptoms. IgG-associated disease may require more exchanges because immunoglobulin removal is less efficient; continue until acute manifestations abate. [18]"
    }
  ],
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  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "Hyperviscosity Syndrome",
      "detail": "www.bmj.com",
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      "snippet": "The threshold of viscosity at which symptoms develop varies considerably from one patient to another and may be much lower in cases with other associated disease. For in-stance, visual symptoms occurred sooner than usual in diabetic patients, who are predisposed to retinopathy.5 6 The diagnosis is e",
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    {
      "number": 2,
      "title": "The Hyperviscosity Syndrome",
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      "snippet": "means of measuring serum viscosity and of making the diagnosis by comparing the viscosity of serum to that of water. Normal values (serum to water) range",
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      "snippet": "by JL Fahey · 1965 · Cited by 350 — The hyperviscosity syndrome commonly includes mucous membrane bleeding, retinopathy and loss of vision, and neurological disorders",
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      "snippet": "Serum protein value remained unchanged. The neurologic find¬ ... symptomatic threshold, the ... Somer T: The viscosity of blood, plasma, and serum in.",
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      "snippet": "Hyperviscosity syndrome caused by cryoglobulinemia diagnosed by observing the reversible formation of gel upon cooling and warming the patient's serum.",
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      "snippet": "The relative serum viscosity was 4.3 (normal, <1.9). The immune complexes measured 0.83 by Clq bindingassay (normal,. <0.10), and the rheumatoid factor was",
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      "number": 7,
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      "snippet": "by MN Menke · 2006 · Cited by 125 — Retinal manifestations of hyperviscosity syndrome occur at lower serum IgM and SV levels than previously reported.",
      "score": 0.27412587
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    {
      "number": 8,
      "title": "Waldenstrom macroglobulinemia: prognosis and ...",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/bcj201528",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "by A Oza · 2015 · Cited by 63 — Hyperviscosity syndrome occurs when the serum viscosity is >4 (viscosity of water is 1), which corresponds to serum IgM of at least roughly",
      "score": 0.52758485
    },
    {
      "number": 9,
      "title": "Exploring effects of platelet contractility on the kinetics ...",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/s44341-025-00011-9",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "by E Kliuchnikov · 2025 · Cited by 10 — ... hyperviscosity syndrome usually present with a plasma/serum viscosity greater than 5 cP. Certain pathological conditions can alter blood",
      "score": 0.46818325
    },
    {
      "number": 10,
      "title": "Rheological properties of blood in multiple myeloma patients | Scientific Reports",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/s41598-024-54947-4",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Article \n    Google Scholar\n15. Hardeman, M. R., Dobbe, J. G. C. & Ince, C. The lasser-assisted optical rotational cell analyzer, (LORCA) as red blood cell ag- gregometer. Clin. Hemorheol. Microcirc. 25, 1–11 (2001).\n\n    CAS \n    PubMed \n    Google Scholar\n16. Słowińska, L. & Monkos, K. Kliniczne z",
      "score": 0.34654185
    },
    {
      "number": 11,
      "title": "Bilateral simultaneous central retinal vein occlusion ...",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/eye2008193",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "by P Alexander · 2008 · Cited by 55 — Serum hyperviscosity affects 15% of patients at diagnosis and is related to the increasing concentrations of IgM pentamers causing erythrocyte",
      "score": 0.29069433
    },
    {
      "number": 12,
      "title": "Management of macroglobulinaemia",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/bjh.14742",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "Hyperviscosity syndrome is the clinical manifestation of hyperviscosity where shear stress causes tearing of capillaries, resulting in",
      "score": 0.53590065
    },
    {
      "number": 13,
      "title": "Efficacy and safety of therapeutic procedure for ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/1744-9987.14094",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by K Ito · 2024 · Cited by 4 — Hyperviscosity syndrome (HVS) is a significant complication in Waldenström's macroglobulinemia (WM), although the significance of plasmapheresis",
      "score": 0.528607
    },
    {
      "number": 14,
      "title": "Waldenström Macroglobulinemia: 2025 Update on ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.27666",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by MA Gertz · 2025 · Cited by 48 — Hyperviscosity syndrome is seen in a decreasing proportion of patients with WM because WM is being diagnosed earlier. Symptomatic",
      "score": 0.49655825
    },
    {
      "number": 15,
      "title": "Waldenström macroglobulinemia: 2023 update on ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26796",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by MA Gertz · 2023 · Cited by 111 — Hyperviscosity syndrome is seen in a decreasing proportion of patients with WM because WM is being diagnosed earlier. Symptomatic hyperviscosity",
      "score": 0.49655825
    },
    {
      "number": 16,
      "title": "Hyperviscosity Syndrome - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/hyperviscosity-syndrome",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "and venous congestion with sausage-like segmentation and papilledema may be seen (Fig. 193-8). The patient occasionally complains of blurring or loss of vision. Dizziness, headache, vertigo, nystagmus, decreased hearing, ataxia, paresthesias, diplopia, somnolence, and coma may occur. Hyperviscosity ",
      "score": 0.6641271
    },
    {
      "number": 17,
      "title": "Leukostasis - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/leukostasis",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Leukapheresis and exchange transfusion have been used to treat hyperleukocytosis. Both are fairly safe procedures and are effective in decreasing the WBC count.17,18 However, their roles in the prevention and management of complications related to leukostasis remain in question. Among children prese",
      "score": 0.66045773
    },
    {
      "number": 18,
      "title": "The use of emergency apheresis in the management of plasma cell disorders",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S147305021830048X",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Hyperviscosity syndrome (HVS) develops most commonly in Waldenström's macroglobulinemia (WM) and multiple myeloma (MM). Plasmapheresis is the immediate therapy and very effective at relieving symptoms by removing paraprotein. The most commonly used replacement fluid is 4%–5% human albumin in physiol",
      "score": 0.5737984
    },
    {
      "number": 19,
      "title": "Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0733862718300282",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by G Emerson · 2018 · Cited by 12 — Leukostasis is defined by symptomatic hyperleukocytosis with neurologic and/or pulmonary manifestations. Acute blast crisis with leukostasis is a rare",
      "score": 0.5634506
    },
    {
      "number": 20,
      "title": "Primary CNS Lymphoma and Neurologic Complications of ...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/continuum/fulltext/2015/04000/primary_cns_lymphoma_and_neurologic_complications.10.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "by L Nayak · 2015 · Cited by 25 — Waldenström macroglobulinemia and IgA or IgG myeloma can lead to hyperviscosity syndrome, resulting in reduced flow through the cerebral and retinal vasculature",
      "score": 0.5417246
    },
    {
      "number": 21,
      "title": "Effect of Plasmapheresis on Hyperviscosity-Related ... - IOVS",
      "detail": "iovs.arvojournals.org",
      "url": "https://iovs.arvojournals.org/article.aspx?articleid=2184720",
      "authors": "iovs.arvojournals.org",
      "host": "iovs.arvojournals.org",
      "snippet": "by MN Menke · 2008 · Cited by 90 — Waldenström's macroglobulinemia (WM) is characterized by an overproduction of immunoglobulin M (IgM), which can lead to a hyperviscosity syndrome (HVS)",
      "score": 0.40995342
    },
    {
      "number": 22,
      "title": "Hyperviscosity‐induced dementia",
      "detail": "www.neurology.org",
      "url": "https://www.neurology.org/doi/10.1212/WNL.33.1.101",
      "authors": "www.neurology.org",
      "host": "www.neurology.org",
      "snippet": "When hyperviscosity-associated dementia is suspected, both serum and whole blood viscosity determinations are indicated. Formats available. You can view the",
      "score": 0.4836734
    },
    {
      "number": 23,
      "title": "Hyperviscosity Syndrome | Critical Care Medicine Section",
      "detail": "www.acep.org",
      "url": "https://www.acep.org/criticalcare/newsroom/newsroom-articles/january-2025/hyperviscosity-syndrome",
      "authors": "www.acep.org",
      "host": "www.acep.org",
      "snippet": "Hyperviscosity syndrome (HVS) is a condition seen in several hematologic disorders characterized by increased blood viscosity leading to impaired microvascular flow and tissue hypoperfusion. The most common cause of HVS is hyperparaproteinemia from plasma cell dyscrasias, usually Waldenström macrogl",
      "score": 0.7009158
    },
    {
      "number": 24,
      "title": "Multiple Myeloma - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK534764",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "A rare side effect is hyperviscosity, which can have severe complications. It typically presents as oronasal bleeding, blurred vision, retinal hemorrhage, seizure, other neurologic symptoms, confusion, dyspnea, and heart failure. This is considered an emergency, and plasmapheresis should be initiate",
      "score": 0.6342494
    }
  ],
  "publishedAt": "2026-08-24T18:15:13.028633+00:00",
  "updatedAt": "2026-08-24T18:15:13.028633+00:00",
  "readingMinutes": 5,
  "slug": "hyperviscosity-syndrome"
}