BLOOD SCIENCES
two main conditions: Waldenstrőm’s macroglobulinaemia (WM) and MM.9
and MacKenzie et al (1970)11 In
MM, HVS is well-established and can be seen in the research of Mehta and Singhal (2003)10
and is also cited in a Clinical Laboratory Measurement of Serum, Plasma, and Blood Viscosity article published in 2006 by Rosencranz and Bogen.12
Harkness (1981) indicates that patients with multiple myeloma exhibit elevated plasma viscosity as a result of monoclonal protein fractions that resemble the size and shape of proteins typically found in plasma; approximately 80% of these patients show an increase in IgG levels, while around 20% demonstrate an increase in IgA levels. In the research conducted by McGrath and Penny (1976), it was found that out of 31 patients with IgG, 25 with IgM, and nine with IgA, 75% exhibited elevated plasma hyperviscosity syndrome.13
They state that: “In each of
the three immunoglobulin classes, the viscosity of blood and plasma increased logarithmically with the paraprotein concentration being greatest in the case of IgM.” This demonstrates a strong association between IgM multiple myeloma and raised PV; as well as an association between IgG and IgA MM and raised PV.
Though, in a 1973 article about HVS in IgA MM, Whittaker, Tuddenham and Bradley discuss how the association was previously thought of as rare, but after finding HVS in 10 IgA MM patients, they state that: “It suggests that IgA multiple myeloma in association with the hyperviscosity syndrome is not as rare as previous reports indicate.”13
The association with MM and serum viscosity (SV) mirrors that of PV, in terms of IgM having a stronger association, and although it is present in IgG and IgA, it is less so.
A paper by Fahey et al. (1965) discusses the long-established association between multiple myeloma and increased serum viscosity, noting that that: “Between 1932 and 1937, Reismann, Magnus-Levy, and Albers reported increased SV in several patients with multiple myeloma.”15
The association has further been
demonstrated in Timo Somer’s chapter in Bailliere’s Clinical Haematology.16
A table
of characteristics and disease features illustrates and presents the percentage increase of SV at presentation of the different types of MM: IgM 95-100%, IgG 80-85% and IgA 85%.
Mehta and Singhal (2003) state that: “Monoclonal hypergammaglobulinaemia resulting in hyperviscosity syndrome is seen in multiple myeloma and Waldenstrőm’s macroglobulinaemia.”10 However, symptomatic hyperviscosity is much more common in Waldenstrőm’s macroglobulinaemia (10-30%) than it is in myeloma (2-6%).
The association between MM and serum viscosity appears to be less well established than of PV. However, establishing SV in MM patients does have clinical significance considering that, ‘prompt recognition of the potentially fatal hyperviscosity syndrome
HVS is characterised by a significant increase in plasma protein concentration or cellular component changes causing impairment of blood flow
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