Bleeding Diathesis in Multiple Myeloma: A Rare Presentation of a Dreadful Emergency With Management Nightmare

Area of Science:

• Hematology
• Oncology

Background:

• Multiple myeloma, a plasma cell neoplasm, frequently presents with coagulation abnormalities.
• Hemorrhagic complications, though uncommon, can be severe and life-threatening in multiple myeloma patients.
• Potential mechanisms include dysfibrinogenemia, paraprotein effects on platelets, and acquired von-Willebrand syndrome.

Observation:

• A 61-year-old female with multiple myeloma experienced hemorrhagic shock.
• The patient's condition was refractory to massive transfusion protocols.
• Acquired dysfibrinogenemia was identified as a contributing factor.

Findings:

• Treatment with dexamethasone and antifibrinolytic infusion targeting dysfibrinogenemia led to clinical stabilization.
• This case illustrates an unusual presentation of hemorrhagic shock secondary to dysfibrinogenemia in multiple myeloma.

Implications:

• Highlights the importance of recognizing and managing rare bleeding complications in multiple myeloma.
• Suggests that antifibrinolytic therapy may be beneficial in specific cases of dysfibrinogenemia-related bleeding in multiple myeloma.
• Underscores the need for tailored treatment strategies for complex hemostatic disorders in plasma cell neoplasms.