An emergency medicine review: Multiple myeloma and its complications

Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality.

This review evaluates MM and its complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

MM is the second most common hematologic cancer and associated with monoclonal plasma cell proliferation. The presentation of MM varies, ranging from few symptoms to end organ injury and failure. The most common presenting findings include anemia, bone pain, renal injury, fatigue, hypercalcemia, and weight loss. While clinical outcomes have improved with known therapies, a variety of complications may occur. Anemia is the most common hematologic complication, though hyperviscosity syndrome, bleeding, and coagulopathy may occur. Renal injury is common, and hypercalcemia is the result of bone demineralization. Infection is a major cause of morbidity and mortality. Osteolytic bone disease is a significant feature of MM, present in 70 % of patients, which may result in pathologic and insufficiency fractures. The most serious neurologic complication includes spinal cord compression, and other neurologic complications include peripheral neuropathy and intracranial involvement. Cardiac toxicity may occur with MM therapies, and there is also increased risk of venous thromboembolism. Endocrine complications may also occur, including adrenal insufficiency and thyroid dysfunction.

An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.