[Severe Hemostatic Dysfunction during Multiple Spinal Fusion Surgery in a Patient with Multiple Myeloma]

Area of Science:

• Hematology
• Oncology
• Surgical Complications

Background:

• Multiple myeloma is a plasma cell malignancy.
• Patients with multiple myeloma can exhibit coagulopathies.
• Surgical procedures in these patients carry a risk of bleeding complications.

Purpose of the Study:

• To report a case of severe hemostatic dysfunction during spinal fusion surgery in a patient with multiple myeloma.
• To highlight the potential link between multiple myeloma and acquired coagulation defects.
• To emphasize the importance of vigilant intraoperative monitoring and management of coagulopathy.

Main Methods:

• Case report of a 74-year-old male patient with multiple myeloma undergoing spinal fusion.
• Preoperative coagulation profile assessment (PT-INR, APTT).
• Intraoperative monitoring of blood loss and coagulation parameters; management with frozen plasma concentrate.

Main Results:

• The patient developed severe bleeding and coagulopathy (PT-INR 9.99, APTT 300 sec) during surgery despite normal preoperative tests.
• Administration of 1,400 ml frozen plasma concentrate corrected PT-INR to 1.04 and APTT to 39.6 sec.
• Surgical hemostasis was achieved after plasma transfusion.

Conclusions:

• Severe hemostatic dysfunction can manifest during surgery in multiple myeloma patients.
• Acquired coagulation deficiency associated with multiple myeloma may be the underlying cause.
• Early recognition and intervention with plasma products are crucial for managing intraoperative bleeding in such cases.