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Management of Hyperviscosity Syndromes

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Evidence-Based Critical Care


The hyperviscosity syndromes are a group of hematologic disorders characterized by (among other symptoms) the classic triad of visual changes, mucosal bleeding, and neurologic deficits. They include disorders of WBCs (hyperleukocytosis), platelets (thrombocytosis), RBCs (erythrocytosis), and elevated protein levels (paraproteinemia). The symptoms of these disorders are the result of an increase in serum viscosity which leads to a relative hypoperfusion. This hypoperfusion can result in catastrophic end organ damage. In the setting of hyperviscosity syndromes secondary to excess WBCs, this is termed leukostasis. Leukostasis is diagnosed empirically when a patient presents with symptoms of tissue hypoxia and is found to have an underlying leukemia with a hyperleukocytosis (WBC >100,000 thou/mL). Leukostasis is a medical emergency and requires immediate stabilization of the patient, which can range from fluid resuscitation to mechanical ventilation. Signs of tumor lysis syndrome should be monitored for and close coordination with oncology is imperative. Ultimately, patients with hyperviscosity from leukocytosis will require a rapid reduction in WBC through a procedure called leukapheresis. Leukapheresis is a temporizing measure performed to decrease symptoms until the diagnosis is made and treatment of the underlying malignancy is initiated.

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  1. Shirley K, McNicholl FP. Blurred vision and epistaxis. BMJ. 2014;348:g91.

    Article  PubMed  Google Scholar 

  2. Wu YK, Huang YC, Huang SF, Huang CC, Tsai YH. Acute respiratory distress syndrome caused by leukemic infiltration of the lung. J Formos Med Assoc. 2008;107(5):419–23.

    Article  PubMed  Google Scholar 

  3. Khan UA, Shanholtz CB, McCurdy MT. Oncologic mechanical emergencies. Emerg Med Clin North Am. 2014;32(3):495–508.

    Article  PubMed  Google Scholar 

  4. Adams BD, Baker R, Lopez JA, Spencer S. Myeloproliferative disorders and the hyperviscosity syndrome. Emerg Med Clin North Am. 2009;27(3):459–76.

    Article  PubMed  Google Scholar 

  5. Kwaan HC. Role of plasma proteins in whole blood viscosity: a brief clinical review. Clin Hemorheol Microcirc. 2010;44(3):167–76.

    CAS  PubMed  Google Scholar 

  6. Késmárky G, Kenyeres P, Rábai M, Tóth K. Plasma viscosity: a forgotten variable. Clin Hemorheol Microcirc. 2008;39(1-4):243–6.

    PubMed  Google Scholar 

  7. Gertz MA, Kyle RA. Hyperviscosity syndrome. J Intensive Care Med. 1995;10(3):128–41.

    Article  CAS  PubMed  Google Scholar 

  8. Lawrence J. Critical care issues in the patient with hematologic malignancy. Semin Oncol Nurs. 1994;10(3):198–207.

    Article  CAS  PubMed  Google Scholar 

  9. Jain R, Bansal D, Marwaha RK. Hyperleukocytosis: emergency management. Indian J Pediatr. 2013;80(2):144–8.

    Article  PubMed  Google Scholar 

  10. Blum W, Porcu P. Therapeutic apheresis in hyperleukocytosis and hyperviscosity syndrome. Semin Thromb Hemost. 2007;33(4):350–4.

    Article  PubMed  Google Scholar 

  11. Gugliotta L, et al. Epidemiological, diagnostic, therapeutic, and prognostic aspects of essential thrombocythemia in a retrospective study of the GIMMC group in two thousand patients. Blood. 1997;90:348a.

    Google Scholar 

  12. Nakanishi T, Suzuki N, Kuragano T, Nagasawa Y, Hasuike Y. Current topics in therapeutic plasmapheresis. Clin Exp Nephrol. 2014;18(1):41–9.

    Article  CAS  PubMed  Google Scholar 

  13. Shelat Suresh G. Practical considerations for planning a therapeutic apheresis procedure. Am J Med. 2010;123(9):777–84.

    Article  CAS  PubMed  Google Scholar 

  14. Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A, McCathy LJ. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma. 2000;39(1-2):1.

    Article  CAS  PubMed  Google Scholar 

  15. Azoulay E, Fieux F, Moreau D. Acute monocytic leukemia presenting as acute respiratory failure. Am J Respir Crit Care Med. 2003;167:1329.

    Article  PubMed  Google Scholar 

  16. Sacchetti A, Grynn J, Pope A, Vasso S. Leukocyte larceny: spurious hypoxemia confirmed with pulse oximetry. J Emerg Med. 1990;8(5):567–9.

    Article  CAS  PubMed  Google Scholar 

  17. Cortes J, Kantarjian H. How I treat newly diagnosed chronic phase CML. Blood. 2012;120(7):1390–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Grund FM, Armitage JO, Burns P. Hydroxyurea in the prevention of the effects of leukostasis in acute leukemias. Arch Internal Med. 1977;137(9):1246–7.

    Article  CAS  Google Scholar 

  19. Stone MJ, Bogen SA. Evidence-based focused review of management of hyperviscosity syndrome. Blood. 2012;119(10):2205–8.

    Article  CAS  PubMed  Google Scholar 

  20. Kwaan HC. Hyperviscosity in plasma cell dyscrasias. Clin Hemorheol Microcirc. 2013;55(1):75–83.

    PubMed  Google Scholar 

  21. Porcu P, Danielson CF, Orazi A, Heerema NA, Gabig TG, McCarthy LJ. Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate. Br J Haematol. 1997;98(2):433–6.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Brian P. O’Connor .

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O’Connor, B.P., Subramanian, I.M. (2017). Management of Hyperviscosity Syndromes. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham.

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