4All of these attributes contribute to HVS and rouleaux formation. In addition, immunoglobulins are cationic and can therefore lower the repulsive forces among normally anionic erythrocytes. 3IgM may bind water through its carbohydrate component and can also form aggregates. Because of its large size, 70% to 90% of IgM produced is found in the intravascular compartment. 2IgM is a large molecular compound that is secreted in a pentamer form and weighs approximately 1 million Da. Approximately 17% of all patients with WM show clinical symptoms related to HVS. Waldenström macroglobulinemia (WM) is a lymphoproliferative B-cell disorder characterized by overproduction of monoclonal IgM 1and is the most frequent diagnosis in patients with hyperviscosity syndrome (HVS) caused by paraproteinemias. Indirect ophthalmoscopy with scleral depression along with retinal vessel diameter measurements are able to detect the earliest hyperviscosity syndrome–related complications and should be considered in the treatment of patients with WM. The mean SV level was 3.1 cP.Ĭonclusions Retinal manifestations of hyperviscosity syndrome occur at lower serum IgM and SV levels than previously reported. The mean IgM level of patients with the earliest retinal changes was 5442 mg/dL. Retinal vessel diameter increased with increasing serum IgM and SV levels. Central retinal changes were associated with significantly higher SV values. Patients exhibited far-peripheral hemorrhages and venous dilation with increasing SV and IgM values. Results A total of 46 patients with WM and 14 age-matched, healthy controls participated in the study. A retinopathy severity scale was developed, and the associated IgM and SV values were related to particular morphologic changes. Hemodynamic findings were compared with those of a group of age-matched controls. Methods Patients with WM were evaluated using indirect ophthalmoscopy with scleral depression, laser Doppler retinal blood flow measurements, and serum IgM and SV determinations. Objectives To determine the earliest retinal changes associated with Waldenström macroglobulinemia (WM) and to ascertain the serum IgM and serum viscosity (SV) levels at which these changes occur.

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