Zhang Y, Xu F, Wen JJ, Shi L, Zhou QL. Isolated coagulopathy without classic CRAB symptoms as the initial manifestation of multiple myeloma: A case report. World J Clin Cases 2022; 10(12): 3822-3827 [PMID: 35647146 DOI: 10.12998/wjcc.v10.i12.3822]
Corresponding Author of This Article
Fang Xu, MD, Academic Fellow, Chief Doctor, Department of Hematology, Mianyang Central Hospital, No. 12 Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, Sichuan Province, China. 147377807@qq.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 26, 2022; 10(12): 3822-3827 Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3822
Isolated coagulopathy without classic CRAB symptoms as the initial manifestation of multiple myeloma: A case report
Ya Zhang, Fang Xu, Jing-Jing Wen, Lin Shi, Qiao-Lin Zhou
Ya Zhang, Fang Xu, Jing-Jing Wen, Lin Shi, Qiao-Lin Zhou, Department of Hematology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
Author contributions: Zhang Y and Fang Xu F contributed equally to this work; Zhang Y and Xu F designed the study; Zhang Y and Wen JJ collected the data; Zhang Y and Xu F analyzed the data; Zhang Y, Xu F, and Wen JJ interpreted the data; Zhang Y, Xu F, Wen JJ and Shi L prepared the manuscript; Shi L and Zhou QL searched and reviewed the literature.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Xu, MD, Academic Fellow, Chief Doctor, Department of Hematology, Mianyang Central Hospital, No. 12 Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, Sichuan Province, China. 147377807@qq.com
Received: July 13, 2021 Peer-review started: July 13, 2021 First decision: November 22, 2021 Revised: December 1, 2021 Accepted: March 4, 2022 Article in press: March 4, 2022 Published online: April 26, 2022 Processing time: 281 Days and 23.8 Hours
Abstract
BACKGROUND
Multiple myeloma patients usually present with CRAB symptoms (hypercalcemia, renal disease, anemia and bone diseases) as initial manifestations. Bleeding symptoms are less common, most of which result from thrombocytopenia or infiltration of plasmacytoma. Relatively, coagulopathy is not so common, especially isolated coagulopathy without CRAB manifestations, which is very rare. Herein, we report a 54-year old female who was hospitalized for intermittent and recurrent mild oral mucosal hemorrhage without other bleeding symptoms for almost one month or typical myeloma features.
CASE SUMMARY
Two months before admission, the patient underwent implantation of a permanent pacemaker due to sick sinus syndrome. Prothrombin time and activated partial thromboplastin time were significantly prolonged. Factor X deficiency was demonstrated to account for the coagulation dysfunction. An M protein peak was shown by serum protein electrophoresis. 26.11% of abnormal plasma cells were detected in bone marrow by flow cytometry, expressing CD38, CD138, CD56 and intracellular immunoglobulin Kappa light chain. Bone marrow biopsy also proved the presence of abnormal plasma cells, but Congo red stain was negative. The patient was finally diagnosed with multiple myeloma IgA-κ type. A literature review indicated that factor X deficiency was highly related to amyloidosis. Before bleeding signs, the patient had cardiac arrhythmia, enlargement of the heart, and progressive heart failure; thus, cardiac amyloidosis was suspected.
CONCLUSION
Bleeding related to coagulation dysfunction is uncommon in multiple myeloma, especially as the initial manifestation. Amyloidosis is a well-recognized cause of isolated acquired factor X deficiency.
Core Tip: Coagulopathy resulting from isolated acquired factorΧ deficiency is uncommon in myeloma. Typical symptoms in multiple myeloma include hypercalcemia, renal disease, anemia and bone diseases (CRAB). Factor Χ deficiency could herald the CRAB symptoms, and was reported to be closely related to amyloidosis. Secondary amyloidosis could be reasonably suspected if factor Χ deficiency is verified in myeloma patient.
