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Hyperviscosity Syndrome

Hyperviscosity Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • Hyperviscosity syndrome (HVS) is the clinical consequence of increased blood viscosity.
  • The classic clinical symptoms are the triad of mucosal bleeding, visual disturbances, and neurologic signs.
  • Viscosity is the resistance a material has to change in form.
  • The higher the blood viscosity, the more the internal resistance to blood flows.
  • Increased cardiac output is required to provide adequate perfusion of hyperviscous blood.
  • Oxygen delivery is impaired as transit through the microcirculatory system slows. This impaired microcirculatory oxygenation gives rise to the clinical symptoms of this syndrome.


  • Hyperviscosity occurs when there is elevation of either the cellular or acellular components of circulating blood.
  • Acellular (protein) hyperviscosity:
    • The most common cause (85–90%) of hyperviscosity is increased concentration of γ globulins:
      • Monoclonal gammopathies: From malignant diseases like Waldenstrom macroglobulinemia and multiple myeloma
      • Polyclonal gammopathies: Usually rheumatic diseases (very rare)
  • Cellular (blood cell) hyperviscosity:
    • Much less common (10–15%)
    • Increased numbers of RBC, as in polycythemia vera
    • Increased concentration (>100,000) of WBC, as in acute and chronic leukemia
    • Thrombocytosis

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Rosen, Peter, et al., editors. "Hyperviscosity Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307255/all/Hyperviscosity_Syndrome.
Hyperviscosity Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307255/all/Hyperviscosity_Syndrome. Accessed April 20, 2019.
Hyperviscosity Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307255/all/Hyperviscosity_Syndrome
Hyperviscosity Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307255/all/Hyperviscosity_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyperviscosity Syndrome ID - 307255 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307255/all/Hyperviscosity_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -