Abstract: SA-PO0105
A Case of Hyperviscosity Syndrome Managed with Plasmapheresis
Session Information
- AKI: Clinical Diagnostics and Biomarkers
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gillman, Nicole, Emory University School of Medicine, Atlanta, Georgia, United States
- Khan, Shabtab, Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Hyperviscosity syndrome (HVS) is a clinical condition marked by increased blood viscosity, resulting in impaired microcirculatory flow and subsequent multiorgan failure. It is often associated with hematologic malignancies such as plasma cell dyscrasias and polycythemia. Elevated immunoglobulin levels contribute to sluggish blood flow and reduced oxygen delivery. Diagnosis is based on clinical presentation and laboratory findings, including serum viscosity. We present a case of HVS in a patient with IgM paraproteinemia requiring plasmapheresis.
Case Description
An 81-year-old male with a history of pleomorphic sarcoma, substance use, new-onset seizures, and IgM paraproteinemia presented with shortness of breath and lethargy. He had recently been diagnosed with influenza and was found to have an acute kidney injury. He was hypoxic and requiring 4L of oxygen. Conditions such as CHF, pneumonia and PE were ruled out. Previously diagnosed with IgM lambda paraproteinemia, a bone marrow biopsy was arranged but was lost to follow-up. Given his history, new seizures, hypoxia, and elevated BNP, HVS was suspected. Serum viscosity was elevated at 5.1(ref. 1.5-1.8), prompting initiation of plasmapheresis. He underwent three sessions of plasma exchange (PLEX), resulting in improved mental status and reduced serum viscosity.
Discussion
HVS is commonly seen in hematologic malignancies secreting high levels of paraproteins. Our patient was diagnosed with Malignant B-cell lymphoma with plasmacytic differentiation, consistent with patient's elevated IgM. The classic triad of HVS includes mucosal bleeding, visual changes, and neurologic symptoms. In this case, symptom attribution was challenging due to confounding factors such as dehydration (elevated creatinine, low bicarbonate, high protein) and recent substance use. PLEX was postponed pending confirmation of the diagnosis through serum viscosity testing. HVS is often missed, but prompt diagnosis and initiation of PLEX can be lifesaving. PLEX involves the removal of high–molecular weight substances—such as paraproteins—from the patient’s plasma, while returning all cellular components to the circulation. A single session can reduce viscosity by 20–30%. Since ~75% of IgM is intravascular, one or two sessions are often sufficient. While PLEX alleviates acute symptoms, long-term management requires chemotherapy to control disease progression and reduce paraprotein levels.