The measurement of viscosity is done in a viscosimeter. Salvage chemotherapy was initiated but failed, and the patient died 17 days later of refractory multiple myeloma. Although epistaxis resolved immediately, the patient’s mentation did not clear and he remained somnolent. The viscosity was then measured as 1.8 cP. A second plasma exchange was performed the following day 3535 mL of plasma were removed and were replaced with 3302 mL of albumin over 70 minutes. After the first plasma exchange, the viscosity was reduced to 3.6 cP. The serum viscosity came back at 13.6 centipoise (cP). A serum viscosity was drawn and sent to the laboratory while plasma exchange was initiated 3479 mL of plasma was removed and replaced with 3304 mL of normal serum albumin over 68 minutes. Total protein was 12.3 g/dL, M spike was 6.6 g/dL, and quantitative immunoglobulin was 7220 mg/dL. His hemoglobin was 7.9 g/dL, and platelet count was 34 × 10 9/L. The epistaxis was both nostrils and could not be stopped with pressure or cautery. At 66 years of age, he presented with epistaxis, gait instability, and somnolence. Over a period of 8 years, he was treated with multiple chemotherapeutic regimens with response and subsequent relapse. A 58-year-old man was diagnosed with immunoglobulin A (IgA) κ multiple myeloma.
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