A 66-year-old man with Waldenstrom macroglobulinemia and serum IgM of 6.5 g/dL reports blurred vision, headache, and recurrent epistaxis. Fundoscopy shows distended, tortuous, sausageshaped retinal veins with scattered hemorrhages. Which intervention addresses the immediate cause of these findings?
- A Rituximab monotherapy
- B Plasmapheresis ✓
- C Platelet transfusion
- D Intravenous immunoglobulin
Correct answer: B. Plasmapheresis
Explanation
The findings describe hyperviscosity syndrome caused by the large pentameric IgM molecule markedly raising serum viscosity, leading to sluggish microcirculation, retinopathy, mucosal bleeding, and neurologic symptoms. Plasmapheresis rapidly removes circulating IgM and is the urgent temporizing measure before definitive systemic therapy takes effect. Rituximab alone can transiently worsen viscosity due to a flare phenomenon, IVIG would add protein load, and platelet transfusion does not correct the underlying rheologic problem.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.