Therapeutic plasma exchange for hyperviscosity syndrome secondary to high rheumatoid factor

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3 Scopus citations


Hyperviscosity syndrome (HVS) is most commonly associated with Waldenstrom's macroglobulinemia, where it may be life-threatening. HVS may also occur in autoimmune diseases; data pertaining to efficacy of therapeutic plasma exchange (TPE) in HVS arising in non-malignant gammopathy are limited. We report a case of 71-year-old female with erosive rheumatoid arthritis with profoundly elevated rheumatoid factor (57,400 IU/ml; normal <35) who presented with findings consistent with HVS: profound weakness, headache, epistaxis and plasma viscosity (8.5 centipoise). She was successfully treated with pulsed high-dose steroids and TPE. Her symptoms of HVS have not recurred and the plasma viscosity has remained less than 3 centipoise. Given a slow onset of non-specific symptoms, HVS may be missed, incurring high risk of adverse effect. In symptomatic patients with high RF activity, a high index of suspicion for HVS is necessary to ensure timely identification and treatment with TPE, a safe and effective therapy.

Original languageEnglish (US)
JournalTransfusion and Apheresis Science
StateAccepted/In press - Jan 1 2018


  • Hyperviscosity
  • Polyclonal gammopathy
  • Rheumatoid arthritis
  • Rheumatoid factor
  • Therapeutic plasma exchange

ASJC Scopus subject areas

  • Hematology


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