Exchange transfusion and pre-filter apheresis dilution for hyperviscosity syndrome refractory to conventional therapeutic plasma exchange in a patient with IgA multiple myeloma.

IF 2.5 3区 医学 Q2 HEMATOLOGY
Transfusion Pub Date : 2025-03-24 DOI:10.1111/trf.18188
Anthony Valin-Thorburn, Sara-Maude Desforges, Daniel Corsilli, Jean-Gilles Guimond, Jean-Philippe Adam, Antonio Maietta, Bertrand Routy, Anne-Sophie Lemay
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Abstract

Background: Significant serum paraprotein elevation leading to hyperviscosity syndrome (HVS) is a rare but serious medical complication that has been well documented in patients with hematological malignancies, including multiple myeloma and Waldenström's macroglobulinemia. This condition can result in severe neurological, renal, and cardiac complications. Standard management of symptomatic HVS includes therapeutic apheresis and the prompt initiation of chemotherapy. Although usually successful, apheresis failure due to extreme hyperviscosity has been documented.

Case report: A 73-year-old Caucasian male with neurological symptoms of HVS secondary to IgA monoclonal gammopathy was transferred to our institution for urgent therapeutic plasma exchange (TPE) and HVS management. Due to severe hyperviscosity, it was impossible to obtain blood analysis, and several attempts at standard TPE failed due to clogging in the apheresis tubing. In this life-threatening situation, manual blood exchanges were successfully performed, followed by pre-filter apheresis dilution. This unconventional approach proved to be effective, allowing subsequent laboratory analysis and the continuation of conventional TPE procedures. The patient remained hemodynamically stable throughout the procedure and was subsequently started on definitive chemotherapy treatment.

Conclusion: This case highlights the importance of prompt recognition of HVS in patients presenting with hematological malignancies. The use of manual exchange transfusion, in conjunction with pre-filter dilution, enabled the successful management of a patient with severe HVS in whom conventional TPE was not possible, illustrating an effective alternative approach in urgent hematological care. It also emphasizes the importance of initiating systemic treatment rapidly for the underlying hematological condition to ensure sustained improvement and prevent recurrence of HVS.

背景:血清副蛋白显著升高导致的高粘滞性综合征(HVS)是一种罕见但严重的医疗并发症,在血液恶性肿瘤(包括多发性骨髓瘤和瓦尔登斯特伦巨球蛋白血症)患者中已有大量记录。这种情况可导致严重的神经、肾和心脏并发症。无症状 HVS 的标准治疗方法包括治疗性血液净化和及时启动化疗。虽然通常能取得成功,但也有因极度高粘度而导致无细胞疗法失败的记录:病例报告:一名 73 岁的白种男性因继发于 IgA 单克隆性腺增生症而出现 HVS 神经症状,被紧急转至我院接受治疗性血浆置换(TPE)和 HVS 治疗。由于血粘度严重过高,无法进行血液分析,而且由于血液透析管道堵塞,多次尝试标准 TPE 均告失败。在这种危及生命的情况下,我们成功地进行了人工换血,然后进行了预过滤无采样稀释。事实证明,这种非常规方法是有效的,可以进行后续的实验室分析,并继续执行传统的 TPE 程序。患者在整个过程中血流动力学保持稳定,随后开始接受明确的化疗:本病例强调了及时识别血液恶性肿瘤患者 HVS 的重要性。在使用人工换血和预滤器稀释的同时,成功救治了一名无法进行传统 TPE 治疗的重度 HVS 患者,为紧急血液病治疗提供了一种有效的替代方法。它还强调了针对潜在血液病迅速启动系统治疗的重要性,以确保病情持续改善并防止 HVS 复发。
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来源期刊
Transfusion
Transfusion 医学-血液学
CiteScore
4.70
自引率
20.70%
发文量
426
审稿时长
1 months
期刊介绍: TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.
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