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Hyperviscosity syndrome in Waldenström macroglobulinaemia — SCE Acute Medicine MCQ

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ModerateCancer, palliative care and haematologyHyperviscosity syndrome in Waldenström macroglobulinaemiaSCE Acute Medicine

A 69-year-old man with known IgM paraproteinaemia presents with headache, blurred vision and mucosal bleeding. Fundoscopy shows venous engorgement, serum viscosity is markedly raised and haemoglobin is 89 g/L. Platelets are normal and CT head is unremarkable. What is the most appropriate next step in management?

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Correct answer: A — Urgent plasma exchange with haematology involvement

Symptomatic hyperviscosity in Waldenström macroglobulinaemia requires urgent plasma exchange to remove paraprotein and improve microcirculatory flow. Red cell transfusion before viscosity is addressed can worsen hyperviscosity. Chemotherapy is important for disease control but is not the immediate stabilising treatment.

Reference: BSH guideline for Waldenström macroglobulinaemia; NICE CKS myeloma-related emergencies