Acquired von Willebrand disease and multiple myeloma

Abstract

Acquired von Willebrand disease (aVWD) is rare disease and is associated with a variety of underlying diseases. We report a case of aVWD in the setting of multiple myeloma. The patient was a 63-year-old female with breast cancer in remission who was admitted for symptomatic anemia. She was diagnosed with multiple myeloma. She also had subcutaneous bleeding before admission. Laboratory studies revealed isolated prolongation of the activated partial thromboplastin time, which corrected in a mixing study. Her factor VIII activity, von Willebrand factor (VWF) Ag, and VWF activity were low. VWF multimer study confirmed the patient had aVWD. The treatment of aVWD is discussed in this article, including the treatment of underlying diseases, and acute management in emergent situations. An intriguing question in this case is whether the patient's multiple myeloma is a chemotherapy-induced hematological malignancy or a second primary malignancy.

Acquired von Willebrand syndrome associated with plasma cell myeloma – a rare histopathological bone marrow image

“…Suspicion of AVWS was raised due to prolonged bleeding after surgical procedure or trephine biopsy of the bone marrow [8,13,14]. Sometimes an increasing tendency to bleed is the first sign of haematological disorder, which leads to the discovery of multiple myeloma, as in the presented case [11,12].…”

“…According to data from the International Registry, 16 out of 186 (9%) AVWS patients were diagnosed with multiple myeloma. Additionally, in the literature there are approximately 30 reported cases of these two disorders in combination [8,9,10,11,12,13,14].…”

“…In several disorders associated with AVWS, surgery, chemotherapy, radiotherapy, or discontinuation of the responsible drugs can sometimes control the underlying disease, with the resolution of the bleeding diathesis and normalisation of the laboratory parameters [2]. Because long-term remission of AVWS associated with plasma cell myeloma with bortezomib and dexamethasone therapy or lenalidomide treatment are observed always the possibility of coexistence with lymphoproliferative malignancy should be eliminated [12,28,29,30,31,32].…”