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Multiple myeloma with hyperviscosity syndrome — uncommon but classic in IgA-MM (M-spike >...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-MM-HYPERVISCOSITY
TypeRed flag
Statusreviewed 2026-04-27 | pending_clinical_signoff
DiseasesDIS-MM
SourcesSRC-ESMO-MM-2023 SRC-NCCN-MM-2025

Red Flag Origin

DefinitionMultiple myeloma with hyperviscosity syndrome — uncommon but classic in IgA-MM (M-spike >5 g/dL, polymerization tendency) or biclonal gammopathy: blurred vision, retinal hemorrhage, mucosal bleeding, neurologic symptoms
Clinical directionhold
Categoryorgan-dysfunction
Shifts algorithmALGO-MM-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "hyperviscosity_symptomatic",
      "value": true
    },
    {
      "finding": "serum_viscosity_above_4cp",
      "value": true
    },
    {
      "finding": "retinal_hemorrhage",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "iga_m_spike_g_dl",
      "threshold": 5
    }
  ],
  "type": "composite"
}

Notes

Hyperviscosity is much rarer in MM than WM (IgM is intrinsically more viscous than IgG/IgA), but IgA-MM with very high M-spike (>5 g/dL) or biclonal disease can produce it. Per NCCN-MM + ESMO-MM 2023: plasmapheresis 1-2 plasma volumes daily until symptoms resolved, THEN initiate cytoreduction. Direction HOLD on routine induction until plasmapheresis underway; priority 10. STUB — requires clinical co-lead signoff.

Used By

Indications