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

Pandey, Soumya; Post, Steven R.; Alapat, Daisy; Smock, Kristi J.; Post, Ginell R.

doi:10.1111/ijlh.12036

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…We found serum M protein concentrations were significantly higher in patients with prolonged PT and were positively correlated with PT, which has also been described by Pandey et al [5]. It is well known that haemorrhagic events and the abnormalities seen in haemostasis screening test results will increase with the progress of the disease.…”

Section: Discussionsupporting

confidence: 88%

“…APTT, von Willebrand factor, factor VIII) and changes in different types of PCD. Pandey et al [5] mainly compared the disease parameters between PT normal and prolonged PCD patients. In our study, the focus was mainly on the correlation between haemostasis and serum M protein concentration in patients newly diagnosed with multiple myeloma, which were not covered or specially emphasized in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…The possible mechanisms of coagulopathy in multiple myeloma were as follows: fibrinolysis was excessive [12,13]; hyperviscosity or oxidative stress affected normal haemostasis function [6,14]; fibrin polymerization and normal platelet and reticuloendothelial system functions were impaired [5,15,16]; some paraproteins exhibit anticoagulant characteristics (i.e. heparin-like activity) [17,18]; and paraprotein disturbs the function of coagulation factor or accelerates the clearance of coagulation factor by forming complexes with specific clotting factors [4,19].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperviscosity of blood, platelet dysfunction, fibrinogen (Fbg) dysfunction, inhibition of coagulation factors or von Willebr and factor, circulating proteins with heparin-like activity have played a part in this process [4,5]; however, the high concentration of paraproteins has always been considered as an important contributor to these mechanisms.…”

Section: Introductionmentioning

confidence: 99%

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Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma

Huang

Li²,

Li³

2015

Blood Coagulation &Amp; Fibrinolysis

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Abnormalities in haemostasis are often detected in patients with multiple myeloma and the fundamental factors that lead to these abnormities are worthy of exploration. The objective of this study was to investigate bleeding diathesis and coagulopathy in different multiple myeloma types or stages and assess how paraprotein concentration contributes to differences in these conditions. Haemostasis screening tests and serum monoclonal protein (M protein) concentration were retrospectively analysed in 101 patients newly diagnosed with multiple myeloma from January 2012 to April 2014. No significant differences were found between bleeding diathesis and types or International Staging System (ISS) stages of multiple myeloma; however, prolonged thrombin time (TT) was found in most of patients (77.7%) and was positively related to light-chain concentration (P ≤ 0.01). Prolonged prothrombin time (PT) was more obvious in IgA and IgG-type multiple myeloma than in the light-chain type (P ≤ 0.01). With increased clinical staging, PT remarkably increased (P ≤ 0.01). M protein concentration was significantly higher in patients with prolonged PT than in those with normal PT (P ≤ 0.01). The D-dimer mean was significantly higher than normal (>0.5 μg/ml) (P ≤ 0.01). Fibrinogen was negatively related to M protein levels (P ≤ 0.01); however, there was no correlation between activated partial thromboplastin time (APTT) and multiple myeloma stages or types, M protein levels and serum light-chain concentration (P ≥ 0.05). Patients with light-chain type multiple myeloma were more likely to have prolonged TT than patients with other types. M protein levels had an obvious effect on PT. Prolonged PT was more common in IgA and IgG-type multiple myeloma. Abnormal haemostasis test results are not always accompanied by clinically apparent haemostatic complications.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma

Huang

Li²,

Li³

2015

Blood Coagulation &Amp; Fibrinolysis

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show abstract

“…Prolonged TT most likely results from acquired dysfibrinogenemia, secondary to multiple myeloma. Fibrin polymerization induced by thrombin was impaired by paraprotein, interacting with γ-chain of the fibrinogen molecule [23]. Light chain paraprotein might have a stronger nonspecific binding effect to fibrinogen and can affect TT more likely than other immunoglobulin types.…”

Section: Discussionmentioning

confidence: 96%

Abnormal hemostasis screening tests leading to diagnosis of multiple myeloma

Iwaniec

Zdziarska

Jurczyszyn

2019

Acta Haematologica Polonica

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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.

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Acquired factor VII inhibitor associated with primary central nervous system Lymphoma: A case report

Goyal

Salmasi

Leavitt

et al. 2022

eJHaem

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Paraneoplastic coagulopathies are uncommon in patients with lymphoma. We report the first case of an acquired coagulopathy in a patient with isolated primary central nervous system lymphoma (PCNSL) demonstrating large-cell histology. In our patient, a paraneoplastic factor VII inhibitor significantly delayed a diagnostic lumbar puncture despite fresh frozen plasma and inactivated prothrombin complex concentrate. While her coagulopathy was effectively overcome with recombinant activated factor VIIa and subsequently with lymphoma-directed therapy, her delayed diagnosis likely contributed to a poor outcome. Our case highlights the importance of rapidly identifying and correcting paraneoplastic coagulopathies when PCNSL is suspected.

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

Cited by 14 publications

References 21 publications

Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma

Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma

Abnormal hemostasis screening tests leading to diagnosis of multiple myeloma

Acquired factor VII inhibitor associated with primary central nervous system Lymphoma: A case report

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