A 71-year-old man presents with headache, blurred vision and spontaneous bruising. Blood tests show haemoglobin 86 g/L (reference range 130–170), total protein 108 g/L (60–80) and serum viscosity 4.8 mPa·s (1.4–1.8). Serum electrophoresis identifies a large monoclonal IgM band, while skeletal imaging shows no lytic lesions. Which diagnosis best explains this presentation?
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