Detection of increased viscosity
Monitoring patients with hyperviscosity syndrome
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Viscosity is the property of fluids to resist flow. Hyperviscosity may be manifested by oronasal bleeding, blurred vision, headaches, dizziness, nystagmus, deafness, diplopia, ataxia, paresthesias, or congestive heart failure. Funduscopic examination reveals dilation of retinal veins and flame shaped retinal hemorrhages.
The most common cause of serum hyperviscosity is the presence of large concentrations of IgM monoclonal proteins, and Waldenstrom's macroglobulinemia accounts for 80% to 90% of hyperviscosity cases. Hyperviscosity syndrome can also occur in multiple myeloma patients.
Because the ability of a monoclonal protein to cause hyperviscosity is affected by its concentration, molecular weight, and aggregation, sera with concentrations of monoclonal IgM >4 g/dL, IgA >5 g/dL, or IgG >6 g/dL should be tested for hyperviscosity.
Serum viscosity and electrophoresis are recommended before and after plasmapheresis in order to correlate viscosity and M-spike with patient symptoms. This correlation may be useful for anticipating the need for repeat plasmapheresis.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
> or =16 years: < or =1.5 centipoises
Reference values have not been established for patients that are <16 years of age.
Although viscosities >1.5 centipoises (cP) are abnormal, hyperviscosity is rarely present unless the viscosity is >3 cP.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test is not suggested in patients with small concentrations of monoclonal proteins.
Hyperviscosity syndrome may not be present even if the viscosity is >3 centipoises.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Gertz MA, Kyle RA: Hyperviscosity syndrome. J Intensive Care Med. 1995;10:128-141