Hemorrhagic Diathesis in Multiple Myeloma

Abstract

Hemorrhage occurs during the clinical course in 15% of patients with multiple myeloma. We recently treated a patient with myeloma who had postoperative bleeding and hematuria despite normal coagulation parameters and platelet count. Platelet function studies revealed markedly abnormal aggregation to all stimulants. Plasma exchange successfully reversed in vitro and in vivo bleeding abnormalities.

Prolonged prothrombin time correlates with serum monoclonal protein concentration in patients with plasma cell dyscrasia

“…Previous reports indicate that bleeding occurs in approximately 15% of patients with IgG and more than 30% of patients with IgA and IgM M proteins . Bleeding was not directly evaluated by the authors of this study; therefore, the incidence of bleeding in this cohort is not known.…”

“…Increased risk of venous thromboembolism in myeloma patients is associated with increased FVIII and von Willebrand factor activity , decreased protein S activity , and acquired resistance to activated protein C . Bleeding occurs in approximately 15% of patients with IgG and more than 30% of patients with IgA and IgM M proteins . Secondary hemostatic defects that result in bleeding diathesis are due to a variety of mechanisms.…”

Specific Binding of Paraprotein to Platelet Receptors as a Cause of Platelet Dysfunction in Monoclonal Gammopathies

“…According to some researchers, this number can reach 15% [23,24]. However, in a group of 43 patients (MM-35, non-Hodgkin's lymphoma grade 3, WM-3 and MGUS-2), laboratory hemostatic disorders occurred in 60% of the examinees, and in 11% symptoms of bleeding were apparent [14,25].…”

Hematuria – look beyond the urinary tract – a rare case Report

“…These include: (a) interference of paraproteins with the normal function of coagulation factors (b) enhanced clearance of coagulation factors by the reticuloendothelial system; (c) anticoagulant activity of paraproteins; (d) abnormal platelet function; (e) excessive fibrinolysis; and (f) hyperviscosity per se . [ 2 3 ] In addition, a series of case reports demonstrated that acquired hemophilia A and acquired von Willebrand syndrome can cause severe bleeding in MM patients. [ 4 ] In our case, the coagulopathy was probably multifactorial.…”