Waldenstrom macroglobulinaemia and hyperviscosity

What it is

Waldenstrom macroglobulinemia is lymphoplasmacytic lymphoma, one of the indolent B cell non-Hodgkin lymphomas. It carries the MYD88 mutation, produces IgM paraproteinemia, and shows small plasmacytoid lymphocytes.

How it presents

The major manifestations are hyperviscosity syndrome, neuropathy, bleeding, hepatosplenomegaly and lymphadenopathy.

An elderly patient with headaches, blurry vision and hepatosplenomegaly is the picture that should bring it to mind; headache, blurred vision and vertigo are the hyperviscosity symptoms in a newly diagnosed patient.