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However, patients with polycythemia vera often present with elevated hemoglobin ( >16 g/dL) and hematocrit (can be as high as 70-80%). Laboratory evaluation includes a complete blood count (CBC), peripheral blood smear, serum electrolytes and serum viscosity.ĬBC: patients with HVS are typically anemic due to their underlying disease. As always, a good history and physical are important. There is no single diagnostic test for HVS. It should be suspected in any patient who presents with the classic triad of neurologic abnormalities, vision changes and mucosal bleeding.

Hyperviscosity is a clinical manifestation of an underlying oncologic process, usually a plasma cell dyscrasia or acute leukemia, though it can sometimes be caused by immune complexes in patients with systemic lupus erythematosis. Similarly, though most patients will be anemic, packed red cells should be transfused extremely cautiously, as this will also increase viscosity. If plasmapheresis is not easily accessible, manual plasma exchange may be performed, in which 1-2 unit phlebotomy is performed with normal saline hydration.Ĭare should be taken when administering fluids and diuresing these patients because aggressive diuresis will increase blood viscosity. While waiting for the plasmapheresis team, a dialysis-compatible central catheter should be placed start supportive therapy to treat bleeding, heart failure and metabolic imbalances. Plasmapheresis may not be readily available in every hospital. Treatment for HVS secondary to excess cellular components should be treated in an analogous manner, with removal of the specific blood component. Plasmapheresis should be initiated as quickly as possible. Definitive therapy is needed to address the underlying condition. These various modalities will only treat the symptoms of HVS. Leukapheresis, plateletpheresis and phlebotomy are used to treat leukostasis, thrombocytosis and polycythemia, respectively. Plasmapheresis is the mainstay of treatment for hyperviscosity secondary to increased plasma proteins. Mucosal bleeding: gingival, mucosal, nasal, vaginal.