Early Recognition of Retinal Signs in Waldenström's Macroglobulinemia: Implications for Therapeutic Plasma Exchange

This report highlights the pivotal role of ophthalmologists in recommending therapeutic plasma exchange (TPE) for systemic disorders like Waldenström's macroglobulinemia (WM). A patient with suspected WM underwent ophthalmic evaluation, revealing peripheral retinal hemorrhages and Roth spots despite no visual complaints. Fundus imaging documented these changes, correlating with elevated IgM levels (86.32 g/L), indicative of hyperviscosity syndrome (HVS). Early retinal findings prompted TPE to mitigate HVS complications. Subsequent bone marrow biopsy confirmed WM with the MYD88 L265P mutation. This case underscores the importance of ophthalmologic insights in guiding hematologic interventions and improving outcomes.