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A 62 year old white female with small cell carcinoma of the lung presented with a prolonged activated partial thromboplastin time (APTT). The patient had no history of abnormal bleeding but previously had pulmonary emboli. Coagulation parameters other than APTT were within normal limits. Pertinent laboratory data included an IgM lambda paraprotein. Dilution studies indicated the presence of a high titer circulating anticoagulant; specific assay revealed marked inhibition of factor VIII (50 Bethesda units). Factor VIII activity was 26% of normal. A purified IgM fraction of the patient’s plasma was obtained by filtration on a Bio-Gel A-1.5m column. When incubated with normal plasma the IgM fraction demonstrated anticoagulant activity by prolonging the APTT.  The patient underwent plasmapheresis with albumin and plasma exchange which significantly corrected the APTT. The combination of small cell carcinoma of the lung and IgM paraprotein with anti-factor VIII activity represents an unusual paraneoplastic syndrome; to our knowledge this combination has not been reported previously.

An IGM Circulating Anticoagulant Associated With Small Cell Carcinoma Of The Lung