Abnormal hemostasis screening tests leading to diagnosis of multiple myeloma

Abstract

Multiple myeloma (MM) is a rare malignancy, characterized by clonal proliferation of plasma cells, secreting monoclonal immunoglobulin. It is usually diagnosed based on histopathologic and immunophenotypic bone marrow examination. Abnormal results of screening coagulation tests, including prothrombin time, activated partial thromboplastin time and thrombin time, are commonly encountered in patients with plasma cell neoplasms. They do not, however, reflect bleeding tendency. We describe a 71-year-old patient who was accidentally diagnosed with multiple myeloma during coagulation diagnostics.

From the Nares to the Bone Marrow: A Role for Transarterial Embolization in an Aberrant Life-Threatening Cause of Epistaxis

“…MM commonly presents with a wide variety of symptoms, which are known as CRAB symptoms [4]. The "C" stands for hypercalcemia, which is seen in approximately 13% of cases, "R" stands for renal failure, which is seen in approximately 20%-40% of cases, "A" stands for anemia, which is seen in approximately 70% of cases, and "B" stands for lytic bone lesions, which are seen in approximately 80% of cases [4]. Other common MM manifestations are weight loss and recurrent infections [4].…”

“…The "C" stands for hypercalcemia, which is seen in approximately 13% of cases, "R" stands for renal failure, which is seen in approximately 20%-40% of cases, "A" stands for anemia, which is seen in approximately 70% of cases, and "B" stands for lytic bone lesions, which are seen in approximately 80% of cases [4]. Other common MM manifestations are weight loss and recurrent infections [4]. The patient we report had renal failure and anemia on presentation; however, these abnormal laboratory results were originally attributed to blood loss and resulting hypoperfusion.…”

“…However, the true prevalence of epistaxis is unknown because most episodes are not reported [3]. MM presenting with epistaxis is rare; hence, MM as the etiologic factor is seldom considered [4]. We herein report a case of a patient diagnosed with MM that initially manifested as a life-threatening nasal bleed; also, we review the association between MM and the tendency of hemorrhage.…”

Bleeding Diathesis in Multiple Myeloma: A Rare Presentation of a Dreadful Emergency With Management Nightmare

“…Multiple myeloma commonly presents with a wide variety of symptoms, known as CRAB symptoms, with C - hypercalcemia (13%), R - renal failure (20%-40%), A - anemia (70%), and B - lytic bone lesions (80%), in addition to weight loss (24%) and recurrent infections [ 4 ]. The National Comprehensive Cancer Network (NCCN) criteria for the diagnosis of active multiple myeloma includes clonal bone marrow plasma cells ≥10%, the presence of biopsy-confirmed bony or extramedullary plasmacytoma, and one or more myeloma-defining events such as hypercalcemia (>1 mg/dl higher than the upper limit), renal failure (creatinine > 2 mg/dL or creatinine clearance < 40 mL/min), anemia (hemoglobin < 10 g/dL or hemoglobin > 2 g/dL below the lower limit of normal), one or more osteolytic bone lesions on skeletal radiography, one or more focal ≥5 mm lesions on MRI scans, clonal bone marrow plasma cells ≥60%, abnormal serum-free light chain (FLC) ratio ≥100 (involved kappa) or < 0.01 (involved lambda) [ 5 ].…”

“…An abnormal coagulation profile, though commonly seen in multiple myeloma, can rarely manifest as life-threatening hemorrhagic complications. Bleeding tendencies in multiple myeloma can be explained by a variety of mechanisms such as dysfibrinogenemia secondary to the inhibition of fibrin monomers by the FAB portion of paraprotein molecules, paraprotein-induced platelet dysfunction, shortened platelet survival, damage to vascular endothelium, and acquired von-Willebrand syndrome [ 4 ].…”