Hyperviscosity syndrome presents with a recognisable clinical triad: mucosal bleeding, visual abnormalities, and neurological abnormalities. When hemorrhagic or central nervous system manifestations are present, prompt intervention is critical.
An apheresis-based intervention is the therapy of choice for patients with hemorrhagic or central nervous system manifestations, and carries category A evidence. It must be initiated immediately — without waiting for viscosity results.
The classic triad of hyperviscosity includes mucosal bleeding, visual abnormalities, and neurological abnormalities.
For patients with hemorrhagic or central nervous system manifestations, plasma exchange is the therapy of choice and is relatively safe.
The standard of care for managing hyperviscosity of the plasma is therapeutic apheresis, and guidelines on the use of apheresis have been previously published, and hyperviscosity is considered category A evidence for plasma exchange.
Plasma exchange should not be delayed awaiting viscosity results, but a sample should be sent for confirmation of the clinical impression.
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