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Hyperviscosity syndrome — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesHyperviscosity syndromeSCE Acute Medicine

A 67-year-old woman presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show visual blurring, mucosal bleeding and markedly raised IgM. What is the most appropriate next step in management?

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Correct answer: A — Arrange urgent plasma exchange

The key discriminator is that visual blurring, mucosal bleeding and markedly raised IgM, which makes Arrange urgent plasma exchange the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Arrange urgent CT imaging and Start anticoagulation after assessing bleeding risk are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://b-s-h.org.uk/guidelines#acute-medicine-order-29-1