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[Preoperative plasmapheresis for lung cancer with multiple myeloma]
Abstract:
A 66-old-male admitted to our hospital was diagnosed multiple myeloma (IgA kappa type, Durie & Salmon stage IIIA) and squamous cell lung cancer (c-T2N0M0 stage I). The function of platelets was within a normal range (11.7 x 10(4)/mm3 and the bleeding time of two minutes), but the function of coagulation was reduced (prothrombin time, 13.1 seconds; activating prothrombin time, 45.1 seconds; and antithrombin III, 65%). The hyperviscosity syndrome was anticipated because of high IgA M protein (6,551 mg/dl). Plasmapheresis with 800 ml of fresh frozen plasma was performed before the left lower pulmonary lobectomy and R1 lymph node dissection. Then the function of coagulation was improved (prothrombin time, 12.6 seconds; activating prothrombin time, 31.3 seconds; and antithrombin III, 75%). IgA M protein was also decreased to 4,696 mg/dl. Postoperative bleeding necessitated a second thoracotomy. The cause of postoperative bleeding was the ablasion of the pleural adhesion due to tuberculous pleuritis as well as bleeding tendency of multiple myeloma. The plasmapheresis performed in this case did not fully improve the bleeding tendency. Cases of cancer complicated with multiple myeloma have been increasing and if an operation is needed, plasmapheresis should be considered. The indication and the extent of hematologic restoration to be achieved should be further investigated.
Insights
This case study highlights a patient with multiple myeloma and lung cancer who underwent surgery. Plasmapheresis improved coagulation but did not fully resolve bleeding issues, suggesting further research is needed.
Area of Science:
- Oncology
- Hematology
- Surgical Oncology
Background:
- Multiple myeloma and lung cancer are increasingly diagnosed together.
- Patients may present with complex hematologic abnormalities complicating surgical management.
Observation:
- A 66-year-old male with IgA kappa multiple myeloma and stage I lung cancer had impaired coagulation.
- High IgA M protein levels suggested a risk of hyperviscosity syndrome.
Findings:
- Plasmapheresis before pulmonary lobectomy improved coagulation parameters and reduced IgA M protein levels.
- Despite plasmapheresis, postoperative bleeding occurred, attributed to pleural adhesions and myeloma-related bleeding tendency.
Implications:
- Plasmapheresis may be considered for managing coagulation disorders in cancer patients with multiple myeloma undergoing surgery.
- Further investigation is required to determine optimal plasmapheresis protocols and hematologic restoration goals in such cases.