Factor X Deficiency Caused by Nonsecretory Myeloma Successfully Corrected with Bortezomib: A Case Report and Review of the Literature

Abstract

A 62-year-old female presenting with anemia and extensive hemorrhages is reported. Coagulation tests showed significantly prolonged prothrombin time (PT) and activated partial thromboplastin time. Decreased levels of clotting factor X activity were determined (5.4%). Bone marrow biopsy revealed neoplastic plasma cells. Serum and urine protein electrophoresis were both negative for monoclonal gammopathy, and both bone marrow and abdominal fat biopsies were negative for amyloid deposition. The patient was diagnosed as suffering from nonsecretory multiple myeloma (MM) complicated by acquired factor X deficiency. A complete response (CR) of the myeloma and recovery of factor X activity (56.6%) were achieved after the administration of treatment, including chemotherapy and bortezomib. We suggest that patients with nonsecretory MM might present with factor X deficiency and should be carefully screened for light chain amyloidosis. Novel agents such as bortezomib should be highly considered as treatment in these patients.

A Case Report of Acquired Factor X Deficiency in a Patient With Multiple Myeloma

“…The presence of factor X deficiency in myeloma without amyloidosis is a rare occurrence. We found three previously published cases describing this rare association [4,5,13]. Two cases described factor X deficiency with improvement after myeloma treatment [4,5].…”

“…We found three previously published cases describing this rare association [4,5,13]. Two cases described factor X deficiency with improvement after myeloma treatment [4,5]. Mufti M et al reported a 20-year-old myeloma patient who developed factor X inhibitor, although amyloidosis was suspected, the workup was negative [13].…”

“…Patients with multiple myeloma may have associated clotting factors deficiency especially if associated with AL amyloidosis [2,3]. Factor X deficiency in multiple myeloma without associated amyloidosis is a rare occurrence and few cases have been described in the literature [4,5]. We describe a patient without previously known hematological disease who presented with bleeding diathesis.…”