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Related Experiment Videos

Bleeding diathesis in multiple myeloma.

M W Saif1, C J Allegra, B Greenberg

  • 1Gastrointestinal Malignancies, UAB Division of Hematology-Oncology, Wallace Tumor Institute, Birmingham, AL 35294-3300, USA. wasif.saif@ccc.uab.edu

Journal of Hematotherapy & Stem Cell Research
|October 24, 2001
PubMed
Summary
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Multiple myeloma patients with high paraprotein levels can experience bleeding disorders. This study shows paraproteins can directly inhibit fibrin formation, causing abnormal coagulation test results.

Area of Science:

  • Hematology
  • Oncology

Background:

  • Multiple myeloma is associated with hemostatic abnormalities, often leading to bleeding.
  • Paraproteins, particularly IgG kappa, can cause coagulopathy.
  • Bleeding complications are more common than thrombotic events in these patients.

Observation:

  • A 56-year-old female with multiple myeloma (IgG kappa, 59 g/L) presented with prolonged thrombin time and prothrombin time.
  • Diagnostic studies revealed coagulopathy.
  • Mixing studies corrected prothrombin time but only partially corrected thrombin time, and did not correct replitase time.

Findings:

  • The paraprotein directly inhibited fibrin monomer aggregation, prolonging thrombin time and replitase time.
  • Protamine administration did not fully correct the prolonged thrombin time, indicating the FAB portion of the paraprotein was involved.

Related Experiment Videos

  • Chemotherapy reduced paraprotein levels to 12 g/L, normalizing coagulation parameters.

    • Implications:

    • Identifies a specific mechanism of bleeding diathesis in multiple myeloma related to paraprotein interference with fibrin polymerization.
    • Highlights the importance of investigating coagulopathy in multiple myeloma patients.
    • Suggests that paraprotein characteristics can predict bleeding risk and guide management.