Hyperviscosity syndrome (HVS) can be caused by various clinical conditions. It can be observed in conditions where the hematocrit is raised, such as polycythemia vera and pseudopolycythemia, or where serum proteins are increased or their composition is altered, such as in paraproteinemias, hyperfibrinogen-emia, or hypoalbuminemia, as well as in inflammatory syndromes, hypothermia, increased red blood cell aggregability, and reduced red cell deformability due to various congenital and acquired conditions, such as sickle cell anemia, hyperlipoproteinemia, thrombosis, or diabetes.1-8

The most common cause of HVS encountered by hematologists is monoclonal and occasional polyclonal paraproteinemias, particularly those characterized by large molecular compounds with a high intrinsic viscosity, such as immunoglobulin M (IgM). Therefore, among cases of HVS caused by paraproteinemias the most frequent diagnosis is Waldenstrom's macroglobu-linemia (WM), a B-cell disorder characterized by overproduction of monoclonal IgM. Approximately 17% of all WM patients show clinical symptoms related to hyperviscosity (HV).9 HVS can also occur in patients with multiple myeloma, malignant lymphoprolifera-tive diseases, lymphoma, monoclonal gammopathy of undetermined significance (MGUS), and primary amyloidosis.210-12 These diseases can occur as a result of a monoclonal paraproteinemia of either IgM, IgG, or IgA.

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