Mucosal bleeding may occur from prolonged bleeding time caused by myeloma proteins interfering with platelet function. Most blood dyscrasias are not diagnosed until the seventh decade. Clinical symptoms are generally related to the triad of mucosal bleeding, visual changes, and neurologic symptoms. Tendency to bleed is the most common symptom of hyperviscosity syndrome. Spontaneous gum bleeding Epistaxis Rectal bleeding Menorrhagia Persistent bleeding after minor procedures Visual changes range from blurred vision to vision loss.
Neurological manifestations are frequent and varied.
The neurological symptoms of hyperviscosity have been referred to as the Bing-Neal syndrome. Vertigo Hearing loss Paresthesias Ataxia Headaches Seizures Somnolence progressing to stupor and coma Other manifestations may include heart failure, fatigue, and anorexia. Bruises, epistaxis, or gum bleeding may be noted. Ophthalmic examination may reveal decreased visual acuity, dilated retinal veins, sausage-linked retinal veins, or retinal hemorrhages. Neurological examination may reveal various findings, including diminished mental status, confusion, ataxia, or nystagmus.