Mayo Medical Laboratories uses the Sonoclot Coagulation Analyzer, which can do coagulation testing, thromboelastography, 10 as well as viscosity measurement. 9 Today, in commercial laboratories, mechanical direct measurement is preferred because the Oswald tube requires 5 mL of serum and requires experienced technicians for it to be reproducible. The ratio between the 2 flow times determines the relative viscosity of the fluid. It involves the use of a stopwatch to measure the flow in seconds, first of water and then remeasuring serum or plasma. 8 This requires significant technical expertise to be reproducible. Its use dates back to the turn of the 20th century and involves measuring the flow of serum or plasma through a capillary tube connected via a U-tube to 2 reservoirs. Historically, this was done using the Ostwald viscosimeter. 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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