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Plasma Viscosity – Definition, Causes and Clinical Relevance

Plasma viscosity measures the thickness and flow resistance of blood plasma. It is an important laboratory marker used to detect inflammation and various blood-related conditions.

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Things worth knowing about "Plasma Viscosity"

Plasma viscosity measures the thickness and flow resistance of blood plasma. It is an important laboratory marker used to detect inflammation and various blood-related conditions.

What is Plasma Viscosity?

Plasma viscosity refers to the thickness or resistance to flow of blood plasma – the liquid component of blood that remains after blood cells such as red blood cells, white blood cells, and platelets are removed. The higher the plasma viscosity, the thicker the plasma and the more slowly it flows through blood vessels. In healthy adults, the normal range is typically between 1.10 and 1.30 mPa·s (millipascal-seconds) measured at 37 °C (body temperature).

How is Plasma Viscosity Measured?

Plasma viscosity is measured in a laboratory using a capillary viscometer or automated analyzers. A blood sample is taken from the patient and the plasma is separated. The time required for the plasma to flow through a standardized capillary tube is then measured. The test is standardized at 37 °C to reflect physiological conditions.

Factors Affecting Plasma Viscosity

Plasma viscosity is primarily determined by the concentration of specific proteins in the blood plasma. The following substances are known to increase viscosity:

Fibrinogen: A clotting protein that rises significantly during inflammation.
Immunoglobulins (antibodies): Especially in immune-related disorders, elevated antibody levels thicken the plasma.
Acute-phase proteins: Proteins produced in response to inflammation or tissue damage, such as C-reactive protein (CRP) and alpha-2-macroglobulin.

Dehydration can also raise plasma viscosity, as reduced fluid intake concentrates the plasma proteins.

Clinical Significance and Associated Conditions

Elevated plasma viscosity can indicate a range of medical conditions and may impair circulation throughout the body:

Inflammatory diseases: Rheumatoid arthritis, Crohn disease, ulcerative colitis, and other chronic inflammatory conditions increase plasma protein levels and therefore viscosity.
Multiple myeloma and Waldenstrom macroglobulinemia: These blood cancers cause abnormally high production of immunoglobulins, potentially leading to hyperviscosity syndrome.
Infections: Both acute and chronic infections raise acute-phase protein concentrations in the plasma.
Liver disease: Conditions such as liver cirrhosis alter protein metabolism, affecting viscosity.
Cardiovascular disease: Elevated plasma viscosity is recognized as a risk factor for thrombosis, stroke, and heart attack, as thicker blood places greater strain on vessel walls and slows circulation.

Hyperviscosity Syndrome

When plasma viscosity is severely elevated, it can lead to hyperviscosity syndrome, a potentially life-threatening condition. Common symptoms include:

Headaches and dizziness
Visual disturbances or temporary loss of vision
Nosebleeds and mucosal bleeding
Neurological deficits and confusion
Cardiac arrhythmias

Hyperviscosity syndrome is a medical emergency. It is typically treated with plasmapheresis – a procedure that filters and removes excess proteins from the blood plasma.

Diagnosis and Interpretation

Plasma viscosity is measured as part of extended blood work or specialized coagulation and inflammation panels. It is commonly evaluated alongside other inflammatory markers such as the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen. An elevated result alone is not diagnostic and must always be interpreted in the context of the full clinical picture.

Treatment

Treatment of elevated plasma viscosity always targets the underlying cause:

For inflammatory conditions: Anti-inflammatory medications such as corticosteroids or immunosuppressants.
For hematological malignancies (e.g., myeloma): Chemotherapy, immunotherapy, or stem cell transplantation.
For acute hyperviscosity syndrome: Plasmapheresis to rapidly reduce viscosity.
General measures: Adequate hydration to dilute plasma and reduce protein concentration.

References

Reinhart, W. H. (2001). Plasma viscosity and its clinical relevance. Schweizer Medizinische Wochenschrift, 131(12), 466–469.
Lowe, G. D. O. et al. (1997). Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. British Journal of Haematology, 96(1), 168–173.
World Health Organization (WHO) – Cardiovascular diseases: risk factors and diagnostic markers. Geneva: WHO Press.

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