Open AccessBleeding due to acquired dysfibrinogenemia as the initial presentation of multiple myeloma
Author(s) -
Namrah Siddiq,
Colin P. Bergstrom,
Larry D. Anderson,
Srikanth Nagalla
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-229312
Subject(s) - medicine , multiple myeloma , dexamethasone , fibrinogen , bleeding diathesis , carfilzomib , gastroenterology , bortezomib , surgery , platelet
Patients with multiple myeloma (MM) are at risk for acquired dysfibrinogenemia resulting in laboratory abnormalities and/or bleeding complications. We describe a 63-year-old man who presented with bleeding diathesis in the presence of a low fibrinogen activity level with a normal fibrinogen antigen level. Further studies revealed elevated levels of lambda free light chains, and he was diagnosed with MM. Despite initiating treatment with bortezomib/dexamethasone, he continued to have recurrent bleeds along with hypofibrinogenaemia, prompting a switch to carfilzomib/dexamethasone. The patient responded with improvement in bleeding symptoms, normalisation of fibrinogen activity and a decrease in serum free light chains.