Case Study: An example of manual plasma exchange in a challenging patient with Hyperviscosity secondary to Waldenstrom's Macroglobulinaemia

Abstract

The case that Is illustrated here is of a 65 year old lady what had been previously been diagnosed with Waldenstrom’s macroglobulinaemia and cryoglobinulinaemia that had never required specific treatment with the exception of regular clinic monitoring. She presents to our institution with progressive neurological symptoms including vertigo and despite normal radiological imaging, fails to improve. Further investigation revealed red cell agglutination as well as increased serum viscosity. Hyperviscosity is suspected as a cause of this patient’s constellation of symptoms and plasma exchange is instituted and fails due to recurrent clotting of the circuit despite numerous preventative measures. Manual plasma exchange was researched and felt to be a viable option and was successfully carried out with resolution of the patient’s symptoms. On her last clinic follow up, our patient has had no recurrence of her symptoms and remains well on chemotherapy with near complete resolution of all symptoms that caused her presentation.