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Hyperviscosity syndrome in myeloma — SCE Acute Medicine MCQ

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HardHaematological EmergenciesHyperviscosity syndrome in myelomaSCE Acute Medicine

A patient with IgA myeloma develops confusion, mucosal bleeding and blurred vision with retinal venous engorgement. Serum viscosity is markedly elevated. What is the immediate treatment?

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Correct answer: C — Start urgent plasma exchange and disease-directed treatment

The best answer is “Start urgent plasma exchange and disease-directed treatment”. This is correct because neurological, visual and bleeding manifestations require rapid removal of circulating paraprotein. Disease-directed therapy prevents recurrence but is too slow for immediate control. Red-cell transfusion may worsen viscosity, and platelet or anticoagulant treatment does not remove the causal protein.

Reference: British Society for Haematology therapeutic-apheresis guideline: https://b-s-h.org.uk/guidelines/guidelines/apheresis-procedures-for-the-treatment-of-patients-and-for-the-collection-of-cellular-therapy-products