The Hyperviscosity Syndromes

Abstract

Impaired blood flow due to abnormal rheologic characteristics results in a multiplicity of clinical manifestations, collectively termed the hyperviscosity syndrome. A basic knowledge of the principles of rheology is important in the understanding of its pathophysiology, especially the relationship between viscosity and flow conditions. The flow characteristics in different types of blood vessels are also determinants in the location of the clinical manifestation. The syndrome can occur in a wide variety of diseases and is best grouped according to the causative element or elements in blood. Abnormalities in the cellular components of blood can occur in the quantity and the quality of erythrocytes, leukocytes, and platelets. Abnormal plasma components can also be in both the quantity and quality of the plasma proteins. Clinical manifestations are the result of vascular occlusion, especially in the microcirculation. The altered rheologic characteristics of either the cellular or the protein component may be temperature dependent, being abnormal only at temperatures below 37 degrees C, so that only the cooler parts of the body are affected. The management of these conditions should be primarily directed at the removal of the abnormal component. At the same time, it should be accompanied by measures that can control the production of the causative element.

Waldenstrom's macroglobulinemia presenting with spinal cord compression: A case report

“…The most characteristic of these is hyperviscosity syndrome which is caused by the increasing serum concentrations of IgM, resulting in aggregation of red cells and increased serum viscosity. It is seen in 15% of WM patients at diagnosis and is clinically characterized by oronasal hemorrhage, visual defects, and multiple neurological abnormalities [9,10]. Other presenting symptoms related to monoclonal IgM include cryoglobulinemia and cold agglutinin hemolytic anemia occurring in 5% of patients [11], peripheral neuropathies in 5-10% [12], and amyloidosis in 2% [13].…”

Blue (or purple) toe syndrome

“…125,126 White cells contribute significantly only with marked leukocytosis. The primary factors affecting plasma viscosity are the levels of fibrinogen, albumin, and globulins.…”

Thrombophilic state in cancer, Part I: Biology, incidence, and risk factors

“…They are the consequence of increased fibrinogen levels, FDPs, acute phase reactants of host origin, and secretions and byproducts of the neoplasm itself (tumor mucins, the breakdown products of tumor necrosis, monoclonal gammopathies, etc.) [20].…”