I. See Also

II. Causes

III. Pathophysiology

  1. Overall increased serum viscosity
  2. Dramatically increased cell counts
    1. Red Blood Cells: Polycythemia Rubra Vera
    2. White Blood Cells: Leukostasis (with White Blood Cells >100,000)
      1. Especially seen in acute leukemic blast crisis (AML or CML)
  3. Increased circulating serum Immunoglobulins
    1. Immunoglobulins coat Red Blood Cells
    2. Results in increased viscosity and sludging
    3. End result is end organ decreased perfusion

IV. Signs

  1. Spontaneous bleeding from mucous membranes
  2. Dyspnea or other respiratory symptoms
  3. Vision change
    1. Hemorrhagic Retinal veins (appear as sausages)
  4. Neurologic symptoms
    1. Headache
    2. Vertigo
    3. Seizures
    4. Altered Level of Consciousness
    5. Peripheral Neuropathy

V. Labs

  1. Complete Blood Count
  2. Serum viscosity: >4-5 centipoise (cP)
    1. Serum viscosity is normally near 1.4 cP
    2. Water viscosity is 1 cP

VI. Management

  1. Oncologic Emergency
    1. Immediate Consultation with hematology and oncology
  2. Temporize
    1. Intravenous fluids
    2. Respiratory support (including intubation if needed)
  3. Decrease cellular load
    1. Multiple Myeloma: Plasmapheresis
    2. Leukostasis: Leukapharesis
    3. Polycythemia: Phlebotomy

VII. References

  1. Aurora and Herbert in Majoewsky (2013) EM:Rap 13(10): 1-4
  2. Higdon (2006) Am Fam Physician 74:1873-80
  3. Zuckerman (2012) Blood 120(10): 1993-2002

Images: Related links to external sites (from Google)

Ontology: Hyperviscosity syndrome (C0221030)

Definition (CSP) any syndrome associated with increased viscosity of the blood; in syndrome of serum hyperviscosity there is spontaneous bleeding and neurologic and ocular disorders; syndromes of polycythemic hyperviscosity is marked by retarded blood flow, organ congestion, reduced capillary perfusion, and increased cardiac effort; syndromes of sclerocythemic hyperviscosity comprise those in which the deformability of erythrocytes is impaired, as in sickle cell anemia.
Concepts Disease or Syndrome (T047)
SnomedCT 11888009
English HYPERVISCOSITY SYNDROME, hyperviscosity syndrome, hyperviscosity syndromes, Hyperviscosity syndrome, Reimann's syndrome, Hyperviscosity syndrome (disorder)
Italian Sindrome da iperviscosità
Japanese 過粘稠度症候群, カネンチョウドショウコウグン
Czech Hyperviskózní syndrom
Hungarian hyperviscositas syndroma
Spanish síndrome de Reimann, síndrome de hiperviscosidad (trastorno), síndrome de hiperviscosidad, Síndrome de hiperviscosidad
Portuguese Síndrome de hiperviscosidade
Dutch hyperviscositeitssyndroom
French Syndrome d'hyperviscosité sanguine
German Hyperviskositaetssyndrom

Ontology: Leukostasis (C0282548)

Definition (MSH) Abnormal intravascular leukocyte aggregation and clumping often seen in leukemia patients. The brain and lungs are the two most commonly affected organs. This acute syndrome requires aggressive cytoreductive modalities including chemotherapy and/or leukophoresis. It is differentiated from LEUKEMIC INFILTRATION which is a neoplastic process where leukemic cells invade organs.
Definition (NCI) A disorder involving the aberrant infiltration and aggregation of leukocytes into the vasculature of the body. Leukostasis is typically detected in the brain and lungs of persons with leukemia. It requires substantial ablative modalities to both reduce the number of cells present and to ensure dispersion of the aggregates.
Concepts Disease or Syndrome (T047)
MSH D018921
SnomedCT 30419000
English Leukostases, Leukostasis, Leukostasis Syndrome, Leukostasis Syndromes, Syndrome, Leukostasis, Syndromes, Leukostasis, Leukostasis [Disease/Finding], Leukostasis (morphologic abnormality)
Japanese 白血球症, ハッケッキュウショウ, 白血球停滞, 白血球停滞症候群
Swedish Leukostas
Czech leukostáza, Leukostáza
Finnish Leukostaasi
Russian LEIKOSTAZ, LEIKOSTAZA SINDROM, ЛЕЙКОСТАЗ, ЛЕЙКОСТАЗА СИНДРОМ
Italian Sindrome leucostasica, Leucostasi
French Syndrome de leucostase, Leucoagglutination, Leucostase
Polish Zespół leukostazy, Leukostaza
Hungarian Leukostasis
Spanish leucoestasis (anomalía morfológica), leucoestasis, leucostasis (anomalía morfológica), leucostasis, Leucostasia, Leucostasis, Síndrome Leucostásico, Sindrome Leucostasico
Portuguese Leucostase, Leucostasia, Síndrome de Leucostasia
Dutch leukostase, Leukostase, Leukostasissyndroom
German Leukostase-Syndrom, Leukostase