Waldenström with symptomatic hyperviscosity syndrome (serum viscosity >4 cp typical, or s...

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

ID	`RF-WM-HYPERVISCOSITY`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-WM`
Sources	`SRC-ESMO-WM-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Waldenström with symptomatic hyperviscosity syndrome (serum viscosity >4 cp typical, or symptomatic at any level): blurred vision, headache, retinal hemorrhage, mucosal bleeding, neurologic dysfunction
Clinical direction	hold
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "finding": "hyperviscosity_symptomatic",
      "value": true
    },
    {
      "finding": "serum_viscosity_above_4cp",
      "value": true
    },
    {
      "finding": "retinal_hemorrhage",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Hyperviscosity is medical emergency requiring plasmapheresis BEFORE any cytotoxic therapy (rituximab can cause IgM "flare" worsening hyperviscosity). Direction "hold" — does NOT shift regimen, but imposes plasmapheresis prerequisite. Rituximab held until IgM reduced.

Used By

Algorithms

ALGO-WM-1L - ALGO-WM-1L
ALGO-WM-2L - ALGO-WM-2L

Indications

IND-WM-1L-DRC - IND-WM-1L-DRC
IND-WM-2L-CARFILZOMIB-CXCR4MUT - IND-WM-2L-CARFILZOMIB-CXCR4MUT
IND-WM-2L-VRD - IND-WM-2L-VRD
IND-WM-2L-ZANUBRUTINIB - IND-WM-2L-ZANUBRUTINIB

Regimens

REG-DRC-WM - Dexamethasone + Rituximab + Cyclophosphamide (DRC) × 6 cycles
REG-VRD-WM - Bortezomib + Rituximab + Dexamethasone (BDR) × 6-8 cycles — chemo-free alternative for r/...