WebThe hyperviscosity slows blood flow and may increase the likelihood of thrombosis and rupture of small blood vessels. Semen rheology and its relation to male infertility. Seminal hyperviscosity is not associated with semenogelin degradation or sperm deoxyribonucleic acid damage: a prospective study of infertile couples. A diagnosis of acute coronary syndrome due to sluggish coronary flow related to hyperviscosity was considered. Hyperviscous Semen Causes Poor Sperm Quality and Male Infertility through Induction of Oxidative Stress. Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma. This involves phlebotomizing about 1 to 2 units of the patient's blood and concurrently replacing it with normal saline. Less commonly seen are cardiopulmonary symptoms such as high output cardiac failure, shortness of breath, valvular dysfunction, or myocardial infarction. Plasma hyperviscosity syndromes are treated by plasmapheresis (plasma exchange) to remove the paraproteins The pathologic rise of acellular components can either be monoclonal or polyclonal. Therapeutic advances in ophthalmology. 2003 Oct:29(5):535-42 [PubMed PMID: 14631553], Chen YY, Yen YF, Lin JX, Feng SC, Wei LC, Lai YJ, Shen YC. The management of hyperviscosity syndrome starts with intravenous hydration and correction of latent iron deficiency. Hyperviscosity syndrome (HVS) is an oncologic emergency that classically presents with the triad of neurological deficits, visual changes, and mucosal bleeding. HVS can be caused by overproduction of nearly any hematologic component but is most common with hypergammaglobulinemia. An important and dreadful feature of hyperviscosity is overt thrombosis in organ systems, resulting in cerebrovascular accident and myocardial infarction. Hyperviscosity may be manifested by nasal bleeding, blurred vision, headaches, dizziness, nystagmus, deafness, diplopia, ataxia, paresthesias, or congestive heart failure. D'Argenio V, Dittfeld L, Lazzeri P, Tomaiuolo R, Tasciotti E. Genes (Basel). Although the frequency of tumor lysis syndrome is increasing in those with solid tumors, it is most common with hematologic malignancies, particularly acute leukemia and high-grade lymphomas. A 12-lead electrocardiogram showed marked ST-segment depression in the left precordial leads and some ST/T changes in anterior and inferior leads [Figure 1]. During history taking, it is important to note any current or past hematological disorders as well as any family history of such conditions. Mentzer WC. This metabolic condition is treated with fluid restriction or hypertonic saline, depending on the speed of development. Superior vena cava syndrome presents as facial edema with development of collateral venous circulation. Extravasation refers to a liquid accidentally leaking into surrounding tissues rather than staying in the blood vessel as intended. Uncommon Causes of Stroke - October 2008. Secondary erythrocytosis in CCHD is a compensatory response to chronic hypoxia which should be carefully managed. This test is not useful for patients with small concentrations of monoclonal proteins. He also had iron deficiency anemia evidenced by microcytic hypochromic red cells and low total serum iron. and transmitted securely. CRC Press; 2012:217-233, The Benson BV200 automated viscometer employs vacuum pressure through a capillary to measure the dynamic viscosity of serum samples. The risk of stroke in sickle cell disease (SCD) varies according to genotype and is highest in patients with homozygous SS. The association of elevated hematocrit and fibrinogen levels with increased stroke risk has led to continued interest in hemorheologic factors and their role in the development of vascular disease and acute stroke. Waldenstrm macroglobulinemia. Blood. Viscosity increases logarithmically at the lowest shear rates and this effect is magnified at higher hematocrit levels. HVS exists as a clinical triad of neurological symptoms, mucosal bleeding, and visual disturbances. Epub [PubMed PMID: 21712172]. To save this book to your Kindle, first ensure coreplatform@cambridge.org There is little or no evidence that elevated HCT levels in individuals living at high altitudes predispose to stroke. Web. The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. Description of the problem Hyperviscosity syndrome (HVS) is a combination of clinical signs and symptoms related to increased blood viscosity. Hyperviscosity syndrome (HVS) is a pathological condition in which blood is thicker than normal and as a result flow is decreased. The highest-risk causative agents include anthracyclines, taxanes, topoisomerase inhibitors, platinums, gemcitabines, vinorelbine (Navelbine), and alkylating agents.3 Febrile neutropenia is associated with increased morbidity and mortality rates, and decreased quality of life.20 Bacterial infections are common in patients with febrile neutropenia, but fungal sources are becoming increasingly prevalent.21. . Gene mutations are often found in the malignant B cells. sharing sensitive information, make sure youre on a federal "corePageComponentGetUserInfoFromSharedSession": true, Semen is Definitions.net. The overall prognosis is poor, with a median survival time of 130 to 140 days.2,24,29,30 Associated cancers include lung, esophageal, and breast cancers; lymphoma; leukemia; and melanoma.1,24,31 Radiation therapy, multiple chemotherapy agents, infection, and autoimmune reactions are other sources.29,31 Rapidly accumulating effusions cause symptoms with as little as 200 mL of fluid, whereas those accumulating more slowly can contain up to 2 L of fluid before severe symptoms are noted.2,24 Most often, patients present with dyspnea, chest pain, or palpitations. (Log in options will check for institutional or personal access. Despite the iron deficiency, she underwent limited phlebotomy with volume replacement by fresh frozen plasma. Concurrent palliative care consultation should be offered to patients with cancer at the time of diagnosis. Hyperviscosity syndrome in splenic marginal zone lymphoma. The key is to treat the primary cause of HVS. Plasma exchange in acute and chronic hyperviscosity syndrome: a rheological approach and guidelines study. In short, hyperviscosity means that the blood becomes thick or gooey and may have difficulty flowing easily through your blood vessels. 2018 Oct:33(5):611-615. doi: 10.1002/jca.21655. The classic finding of "sausage link" or "boxcar" engorgement of retinal veins can be seen on the fundoscopic exam as well as papilledema, flame-shaped hemorrhages, or exudates. Therapeutic phlebotomy was done followed by fresh frozen plasma infusion. John A St Abstract Many of the complications of severe coronavirus disease-2019 (COVID-19) are caused by blood hyperviscosity driven by marked hyperfibrinogenemia. 1995;10:128-141, 2. 2022 Oct 14;12(6):20220048. doi: 10.1098/rsfs.2022.0048. Radiation-related dermatitis, cardiovascular disease, esophagitis, cystitis, sexual dysfunction, and depression are common.38 Adverse reactions can occur at varying times posttreatment, ranging from those that resolve within a few months to new cancers occuring a decade or more after treatment. Before hasContentIssue false, HEREDITARY AND GENETIC CONDITIONS AND MALFORMATIONS, VASCULAR CONDITIONS OF THE EYES, EARS, AND BRAIN, SYSTEMIC DISORDERS THAT ALSO INVOLVE THE CEREBROVASCULAR SYSTEM, MICROSCOPIC POLYANGIITIS AND POLYARTERITIS NODOSA, RHEUMATOID ARTHRITIS AND CEREBROVASCULAR DISEASE, CALCIUM, HYPERCALCEMIA, MAGNESIUM, AND BRAIN ISCHEMIA, KOHLMEIER-DEGOS DISEASE (MALIGNANT ATROPHIC PAPULOSIS), STROKE IN PATIENTS WHO HAVE INFLAMMATORY BOWEL DISEASE, SWEETS SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS), NEPHROTIC SYNDROME AND OTHER RENAL DISEASES AND STROKE, MITOCHONDRIAL AND METABOLIC CAUSES OF STROKE, BONE DISORDERS AND CEREBROVASCULAR DISEASES, NONINFLAMMATORY DISORDERS OF THE ARTERIAL WALL, VASOSPASTIC CONDITIONS AND OTHER MISCELLANEOUS VASCULOPATHIES. 06 January 2010. On admission, serum troponin I was elevated at 37312 ng/L (reference limit <19 ng/L). The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. These patients have almost no symptoms or mild symptoms of hyperviscosity. This content is owned by the AAFP. Epub 2018 Sep 6 [PubMed PMID: 30188580], Adam MP, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, Bento C, McMullin MF, Percy M, Cario H. Primary Familial and Congenital Polycythemia. Hypofunction of the prostate or seminal vesicles causes abnormal viscosity of seminal fluid. Summarize the treatment options for hyperviscosity syndrome. Keep specimen at 37 degrees C (eg, 37 degrees C Thermopak, heat block) until after centrifugation. Epub 2019 Jan 8 [PubMed PMID: 30671569], Abrams RMC, Elder GA. Safety of Therapeutic Plasma Exchange for the Treatment of Guillain-Barr Syndrome in Polycythemia Vera. the contents by NLM or the National Institutes of Health. Cryoglobulinemia can also lead to small-vessel vasculitis, which can cause purpura; hyperviscosity and direct vascular trauma can contribute. Complications of cancer treatment are becoming more varied because of the use of standard and newer immunologic therapies. Metabolic disturbances can result in hyperviscosity and an increase in the brains water content, leading to a decrease in cerebral blood flow and intracellular acidosis [ 13, 14, 15 ]. Repeated phlebotomy, on the other hand, leads to depletion of body iron store. Experience from 1050 completed plasmapheresis treatment sessions]. [1,4], Once dehydration and iron deficiency are ruled out as precipitating causes of hyperviscosity symptoms, phlebotomy may be safely performed with concomitant volume replacement. 2022 Mar 26;15:2019-2031. doi: 10.2147/JIR.S339515. This correlation may be useful for anticipating the need for repeat plasmapheresis. Neonatal hyperviscosity: randomized study of effect of partial plasma exchange Indian journal of pediatrics. The most common cause of hyperviscosity syndrome is Waldenstrom macroglobulinemia. Other causes may include: Acute myeloid leukemia (AML). Chronic hypoxia, lack of oxygen to your tissues. Connective tissue diseases, such as rheumatoid arthritis or lupus. Cryoglobulinemia. Essential thrombocythemia, too many blood platelets. Leukemia. Therapeutic phlebotomy was done in two sessions 48 hours apart, followed by fresh frozen plasma and normal saline infusion. Oncologic Emergencies: Recognition and Initial Management. Thrombomodulin (TM) which is a vascular endothelial cell surface receptor acts as an important mediator for thrombin-mediated activation of Protein C which governs the anticoagulant activity of endothelium. 2016 Oct:175(1):77-86. doi: 10.1111/bjh.14196. Sickle cell disease and spherocytosis can also contribute to HVS due to deformed red blood cells. An official website of the United States government. It is sometimes the only treatment option for recurring obstructive tumors.2,24 Patients with cancer-related superior vena cava syndrome usually have advanced disease, and median survival is six months from presentation (although many survive more than two years).2 Inpatient treatment with oncology and cardiothoracic surgery consultation, as well as consideration for palliative care consultation, is recommended.24. Management consists of supportive care with intravenous fluids, plasmapheresis, and treatment of the underlying hematological condition. [12], The incidence of arterial thrombosis seen in patients with PV is 12%, venous thrombosis 9%, and major hemorrhage 4.2%. Rose SS, Shah AA, Hoover DR, Saidi P. Cyanotic congenital heart disease (CCHD) with symptomatic erythrocytosis. WebThe exact cause of too much production of the IgM antibody is unknown. on the Manage Your Content and Devices page of your Amazon account. Approximately 17% of acute care sought by patients with cancer is attributable to gastrointestinal problems, which are increasingly associated with opioid or immunologic therapy. Emergent use of antibiotics in patients with cancer who present with febrile neutropenia improves survival rates. Ejaculation: the Process and Characteristics From Start to Finish. 8600 Rockville Pike Depending on the treatment modality used (cytokines, vaccines, adoptive cell therapy, or checkpoint inhibitors), multiple toxic expressions can occur with cancer immunotherapy and are collectively referred to as immune-related adverse effects3941 (Figure 2). Plasma hyperviscosity is a rare complication of both monoclonal and polyclonal disorders associated with elevation of immunoglobulins. See permissionsforcopyrightquestions and/or permission requests. It is suggested that deranged endothelial function could be an important factor for down-regulation, loss and/or internalization of TM resulting in thrombin-thrombin receptor interaction on the surface of endothelial cells, activation of various procoagulant pathways which finally leads to intravascular thrombosis. WebConditions that cause an abnormal protein content in the blood, typically in the form of immunoglobulins, can affect vascular fragility and lead to purpura. Secondary erythrocytosis occurs in cyanotic heart disease as a physiological response to chronic hypoxia, and this leads to hyperviscosity and various complications of the same. Monitoring patients with hyperviscosity syndrome. [10], High HCT level is directly related to vascular occlusion and neurological events like stroke in primary polycythemia (PV). On admission, the right lower limb was markedly cold and edematous with bluish discoloration, and the right pedal pulse was not palpable. Patients with SIADH may present with gastrointestinal and neurologic symptoms. A serum viscosity of more than 4 cP suggests hyperviscosity syndrome.24, Treatment includes plasmapheresis followed by targeted chemotherapy. She recovered uneventfully after surgery and was discharged home in stable condition. HHS Vulnerability Disclosure, Help Therefore, judicious fluid administration is advised. Kotby AA, Mamdouh NM, Eissa DS, Ahmed NT. "coreDisableSocialShare": false,
