From the Guidelines
Hyperproteinemia criteria in hyperviscosity syndrome are typically considered when IgM levels exceed 4 g/dL, as recommended by the IWWM-7 consensus 1. In the context of Waldenström macroglobulinemia, this threshold is critical for determining the risk of symptomatic hyperviscosity. The IWWM-7 consensus guidelines suggest that patients with IgM levels ≥ 4 g/dL may benefit from preemptive plasmapheresis before rituximab therapy to avoid symptomatic IgM flare 1. Key considerations for managing hyperviscosity syndrome include:
- Monitoring IgM levels and serum viscosity
- Plasmapheresis for acute symptomatic relief
- Treating the underlying condition with chemotherapy or other targeted therapies
- Maintaining hydration to reduce serum viscosity The specific threshold for clinical concern may vary depending on the underlying cause of hyperviscosity, but in general, IgM levels above 4 g/dL are considered a critical threshold for intervention 1. It is essential to individualize treatment based on the patient's symptoms, protein levels, and overall clinical condition, rather than relying solely on absolute protein levels. Regular protein electrophoresis, viscosity measurements, and vigilance for symptoms like visual disturbances, neurological changes, and bleeding are crucial for early detection and management of hyperviscosity syndrome.
From the Research
Hyperproteinemia Criteria in Hyperviscosity Syndrome
- Hyperproteinemia is a condition characterized by an excess of proteins in the blood, which can lead to hyperviscosity syndrome 2, 3, 4, 5, 6
- Hyperviscosity syndrome is a life-threatening complication that can occur in patients with paraproteinemia, multiple myeloma, and other conditions 2, 3, 4, 5, 6
- The diagnosis of hyperviscosity syndrome is typically made by measuring plasma or serum viscosity using a viscometer, as well as funduscopic examination 3
- Clinical manifestations of hyperviscosity syndrome include neurological impairment, visual disturbance, and bleeding 3, 6
Treatment of Hyperviscosity Syndrome
- Treatment of hyperviscosity syndrome typically involves plasma exchange, also known as therapeutic plasma exchange (TPE) 2, 3, 4, 5, 6
- Plasma exchange involves the removal of plasma and replacement with a substitute solution, such as albumin or fresh frozen plasma 4
- The goal of plasma exchange is to reduce the concentration of paraproteins and relieve symptoms of hyperviscosity syndrome 2, 3, 4, 5, 6
Hyperproteinemia and Hyperviscosity Syndrome
- Hyperproteinemia can lead to hyperviscosity syndrome by increasing the resistance to blood flow and impairing transit through the microcirculatory system 6
- The most common causes of hyperproteinemia leading to hyperviscosity syndrome are increased concentrations of gamma globulins, either monoclonal or polyclonal 6
- Other conditions, such as polycythemia vera and extreme increases in white blood cell counts, can also produce hyperviscosity syndrome 6