[Music] what is hyper viscosity of course viscosity of any fluid which essentially in very simple terms as a non physicist that just tells you about the thickness of that fluid and here we are concerned about the viscosity of blood or plasma which is circulating in our bloodstream and there are situations where our blood becomes stick or more viscous which is not good for circulation because it can cause problems and symptoms that can become potentially life-threatening so when the viscosity of the circulating or circulating blood or plasma becomes high or goes up that is by definition hyper viscosity and there are two broad categories or two main reasons for hyper viscosity either we have more blood cells especially more red cells or white cells or we have high amount of protein in the blood especially larger protein elements so from myeloma perspective and from Waldenstrom's macroglobulinemia perspective which is a related disease the high viscosity is caused by a high protein level in the blood it could be either a very high IgM level in Waldenstrom's macroglobulinemia or very high level of IgG or IgA level IgM is more commonly associated with hyper viscosity because it is a bigger molecule and as a result it makes blood thicker faster and why is hyper viscosity bad because it affects the circulation and patients have symptoms so patients develop hyper viscosity they can notice symptoms that essentially point towards interference with the flow of blood and the more common symptoms associated with hyper viscosity are some kind of reading these patients and to have bleeding from on the nose or gums so that is one symptom associated with hyper viscosity the second symptom that is common with hyper viscosity again it because of the flow of blood in the retina or I and these patients can have some visual blurring and floaters and situations like that so visual symptoms with some bleeding and then this can also cause neurologic symptoms so patients may notice dizziness they may have confusion some patients may present with shortness of breath and in extreme cases it can even cause seizures and coma but again luckily most of the patients present early and especially depending on the type of disease when we suspect that we do the right yes and that way we can help which can help us in making the diagnosis so that is the definition of hyper viscosity especially as it pertains to plasma cell disorders as well as Warren stones macroglobulinemia is hyper viscosity treatable myeloma patient so fortunately do not suffer that much from hyper viscosity as the warden stones patients do but yes absolutely it is directly related to the amount of protein in the blood so if someone starts out with an M protein of eight grams and an IgG level of 13 gram and once you give that patient say two cycles of induction treatment and the total protein level goes down IgG level goes down M protein goes down and with that viscosity goes down and the symptoms go away but there are other ways of treating hyper viscosity symptoms relatively rapidly and that includes a procedure called plasmapheresis where basically you connect through a venous catheter or a-line patients way into a machine and the blood can circulate through the Machine which is designed or programmed to take out excess protein so there one can relieve the symptoms right away within a few you can remove the excess protein but then this is not the definitive measure because the underlying cause which is increased production of protein persists so that has to be treated with auntie myelin or anti Waldenstrom's treatment but a procedure like plasmapheresis or plasma exchange can rapidly lower the protein and help relieve the symptoms [Music]