melphalan and Hematoma

This is a retrospective study on six multiple myeloma patients with upfront coagulopathy and bleeding. A detailed description and analysis of clinical characteristics, coagulation factor deficiencies, treatments and outcome of those six multiple myeloma patients are presented. All six patients presented with significant bleeding. One patient was detected with single factor X deficiency and another with single factor VII (FVII) deficiency, whereas four other patients had complex factor deficiencies. The time from symptom presentation to diagnosis ranged from 3 to 10 months. After correct diagnosis and coagulation factor supplementation, those patients were treated with bortezomib/adriamycin/dexamethasone (PAD) or melphalan/dexamethasone/thalidomide (MTD) regimen. It took 29-71 days (median time 46 days) to completely correct coagulation factor deficiencies since the start of therapy for multiple myeloma. Multiple myeloma patients with acquired bleeding disorders may present with large, deep and multiple sites of haematoma or other types of significant bleeding, which may affect bone marrow examination in some of the cases. Patients may be easily misdiagnosed. The routine examinations of erythrocyte sedimentation rate, serum immunoglobulins and blood urine light chain are the key to diagnosis, hence requiring the treating physician to think broadly and look for traits suggesting myeloma as the underlying cause.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Blood Sedimentation; Boronic Acids; Bortezomib; Coagulants; Coagulation Protein Disorders; Dexamethasone; Doxorubicin; Female; Hematoma; Hematuria; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Pyrazines; Retrospective Studies; Thalidomide

A 65-year-old male patient presented with right upper-quadrant abdominal pain. Ultrasonography revealed hypoechoic lesion in the perihepatic and intraparenchymal area. Computed tomography (CT) showed hypodense lesion in the same localization. A fine needle biopsy specimen of the perihepatic lesion was hemorrhagic. On abdominal CT, the liver showed enhancement, but the spleen did not enhance. The spleen could not be detected by scintigraphic imaging using Tc99m sulfur dioxide. A diagnosis of primary amyloidosis was made by renal biopsy. Melphalan 10 mg/day for 4 days/month was started. The clinical and radiological follow up demonstrated a resorption of the hematoma. The patient is still alive at the eighth month of therapy.

Topics: Abdominal Pain; Aged; Amyloidosis; Biopsy, Needle; Diagnosis, Differential; Follow-Up Studies; Hematoma; Humans; Immunohistochemistry; Liver Diseases; Male; Melphalan; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler

Four basic coagulation tests, the prothrombin time, thrombin time, partial thromboplastin time, and prothrombin consumption time, were used, with relatively simple modifications, to demonstrate the presence of two circulating anticoagulants in the blood of a patient with IgG myeloma and a severe bleeding tendency.

Topics: Antithrombins; Blood Coagulation Tests; Ear Diseases; Factor IX; Factor V; Factor VIII; Hemagglutination Inhibition Tests; Hematoma; Hemorrhage; Hot Temperature; Humans; Immunoelectrophoresis; Immunoglobulin G; Male; Melphalan; Middle Aged; Multiple Myeloma; Plasmapheresis; Prednisone; Prothrombin Time; Thromboplastin