Waldenström J G
Acta Med Scand. 1984;216(5):467-74.
The indications for plasmapheresis in the different hyperviscosity syndromes are discussed on the basis of data on relative serum viscosity at 13 and 37 degrees C. Beside monoclonal macroglobulinemia there are conditions with a high content of polyclonal IgM and also of IgG and IgA where hyperviscosity is a dominant symptom. The importance of what may be called macroglobulinemia polyclonalis spuria is stated and a number of patients belonging to this type are discussed. Polyclonal increase in IgG, even at high levels, usually does not cause severe hyperviscosity. Case histories of patients with rheumatoid disease and marked hyperviscosity constitute one group. Another is formed by diseases leading to the development of immune complexes. Such complexes are usually caused by binding of polyclonal IgG to monoclonal IgM, but other combinations are also known. A number of clinical examples of these different disease conditions, some probably indicating intense plasmapheresis, are analyzed. The limited value of plasmapheresis alone without cytostatic treatment is stressed as regards hyperviscosity. Another indication is removal of noxious protein components.
基于13摄氏度和37摄氏度时相对血清粘度的数据，讨论了不同高粘滞综合征中血浆置换的适应症。除单克隆巨球蛋白血症外，还有多克隆IgM以及IgG和IgA含量高的情况，其中高粘滞是主要症状。阐述了所谓假性多克隆巨球蛋白血症的重要性，并讨论了一些属于该类型的患者。即使IgG水平很高，其多克隆增加通常也不会导致严重的高粘滞。类风湿疾病伴明显高粘滞患者的病例构成一组。另一组是由导致免疫复合物形成的疾病组成。此类复合物通常由多克隆IgG与单克隆IgM结合引起，但其他组合也有报道。分析了这些不同疾病状况的一些临床实例，其中一些可能表明需要强化血浆置换。强调了在高粘滞方面，单纯血浆置换而不进行细胞抑制治疗的价值有限。另一个适应症是去除有害的蛋白质成分。
