skip to main content

Hyperviscosity syndrome in Waldenstrom macroglobulinaemia — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardHaematological EmergenciesHyperviscosity syndrome in Waldenstrom macroglobulinaemiaSCE Acute Medicine

A 69-year-old man with known Waldenstrom macroglobulinaemia presents with headache, blurred vision and mucosal bleeding. Fundoscopy shows venous engorgement, IgM is markedly elevated and plasma viscosity is high. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Arrange urgent plasma exchange

Neurological symptoms, visual disturbance, mucosal bleeding and high viscosity in IgM paraproteinaemia indicate hyperviscosity syndrome requiring urgent plasma exchange. Rituximab may treat the underlying disease but is too slow and can initially worsen IgM flare. Venesection is for polycythaemia, not paraprotein viscosity. This is a classic presentation where symptom control precedes definitive chemotherapy.

Reference: BSH Waldenstrom macroglobulinaemia guideline, BNF